Evaluation of Lynch Syndrome Screening in VISN22: Clinical and Budget Impact

描述(由申请人提供)： 越来越多的人可以进行基因检测，特别是对许多遗传性癌症综合征，如林奇综合征，这是遗传性结直肠癌最常见的形式。由于结直肠癌和子宫内膜癌的高风险、其他类型癌症的风险增加、可用的筛查和降低风险的选择以及受影响的家庭成员预防癌症的潜力，识别林奇综合征患者非常重要。VHA基因组医学计划咨询委员会建议将林奇综合征作为退伍军人群体的优先事项，因为它是一种与退伍军人群体相关的相对常见的遗传疾病，而且有大量证据支持对这种疾病进行筛查和诊断测试的临床有效性和实用性。对于这个试点项目，我们建议研究VISN 22 Lynch综合征筛查计划的临床和预算影响。目前在VHA内还没有系统的方法来筛查林奇综合征；这项工作是了解这种筛查对退伍军人人群的影响的重要一步。为了实现拟议项目的目标，我们将进行以下具体目标：目标1.评估22个林奇综合征筛查计划实施前后林奇综合征筛查的频率。目的2.在实施筛查计划后，确定与VISN 22中的林奇综合征筛查相关的患者、提供者和设施层面的因素。目的3.确定林奇综合征筛查方案的成本以及在VISN 22中实施林奇综合征筛查计划的潜在预算增量影响。在退伍军人中筛查林奇综合征的好处还没有被研究过。具体地说，目前尚不清楚退伍军人群体中是否存在可能影响林奇综合征筛查计划结果的差异。这一拟议的HSR&D试点项目的总体目标是评估Lynch综合征筛查率和VISN 22 Lynch综合征筛查计划的预算影响。这项工作之所以重要，是因为它考虑了一个对患者既有医疗保健责任又有受托责任的综合医疗组织的视角。我们的发现将有助于未来在VHA内实施Lynch综合征筛查的战略规划和政策制定，下一步将包括将Lynch综合征筛查扩展到其他VISN。

DESCRIPTION (provided by applicant): Genetic tests are increasingly available, especially for many of the hereditary cancer syndromes, such as Lynch syndrome, which is the most common form of hereditary colorectal cancer. Identification of patients with Lynch syndrome is important due to the high risk of colorectal and endometrial cancer, the increased risk of other types of cancers, available screening and risk-reduction options, and the potential for prevention of cancer in affected family members. The VHA Genomic Medicine Program Advisory Committee suggested Lynch syndrome as a priority for the Veteran population since it is a relatively common genetic condition relevant to the Veteran population, and there is substantial evidence supporting the clinical validity and utility of screening and diagnostic tests for this disorder. For this pilot poject, we propose to study the clinical and budget impact of the VISN 22 Lynch syndrome screening program. There is currently no systematic approach to screening for Lynch syndrome within VHA; this work is an important step to understand the implications of such screening in the Veteran population. To accomplish the goals of the proposed project we will conduct the following specific aims: Aim 1. Assess the frequency of Lynch syndrome screening before and after implementation of the VISN 22 Lynch syndrome screening program. Aim 2. Identify patient, provider and facility-level factors associated with Lynch syndrome screening within VISN 22 after implementation of the screening program. Aim 3. Determine the costs of the Lynch syndrome screening protocol and the potential incremental budget impact of implementing the Lynch syndrome screening program in VISN 22. The benefits of Lynch syndrome screening within the Veteran population have not been studied. Specifically, it is not known whether there are differences in the Veteran population that might influence the results of a Lynch syndrome screening program. The overarching goal of this proposed HSR&D Pilot project is to evaluate the rates of Lynch syndrome screening and the budget impact of the VISN 22 Lynch syndrome screening program. This work is important because it considers the perspective of an integrated healthcare organization that has both health care and fiduciary responsibilities to its patients. Our findings will contribute to future strategic planning and policy making regarding implementation of Lynch syndrome screening within VHA and next steps will include expansion of Lynch syndrome screening to other VISNs.