Demographic Differences Among US Department of Veterans Affairs Patients Referred for Genetic Consultation to a Centralized VA Telehealth Program, VA Medical Centers, or the Community

Scheuner, Maren T.; Huynh, Alexis K.; Chanfreau‐Coffinier, Catherine; Lerner, Barbara; Gable, Alicia R.; Lee, Martin; Simon, Alissa; Coeshott, Randall; Hamilton, Alison B.; Patterson, Olga V.; DuVall, Scott L.; Russell, Marcia M.

doi:10.1001/jamanetworkopen.2022.6687

Cited by 7 publications

(13 citation statements)

References 32 publications

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“…Twenty-five included studies 8 , 11 , 12 , 14 – 16 , 19 – 22 , 24 , 25 , 27 , 28 , 30 , 32 , 33 , 35 , 37 , 39 – 44 met all our risk of bias criteria. These good quality studies were given more weight in our narrative synthesis than studies that did not meet one or more criterion.…”

Section: Resultsmentioning

confidence: 99%

“…These outcomes were reported in five studies of cardiovascular disease, 10 , 11 , 26 , 32 , 39 three studies of nursing home care, 24 , 25 , 31 four studies of dialysis and end stage renal disease, 9 , 27 , 42 , 43 three studies of mental health conditions, 18 , 38 , 44 two studies of hospital safety indicators and outpatient clinical quality of care, 8 , 12 two studies of cancer, 34 , 36 two studies of chronic obstructive pulmonary disease, 28 , 41 and five studies of miscellaneous conditions. 14 , 20 , 37 , 13 , 17 Sixteen studies 8 , 11 , 12 , 14 , 20 , 24 , 25 , 27 , 28 , 32 , 37 , 39 , 41 – 44 were of study good quality, and ten 9 , 10 , 13 , 17 , 18 , 26 , 31 , 34 , 36 , 38 were of fair study quality. VA care was better in 15 of these studies, 11 – 14 , 17 , 20 , 24 – 28 , 34 , 37 , 42 , 44 including 5 studies 11 , ...…”

Section: Resultsmentioning

confidence: 99%

“… 14 , 20 , 37 , 13 , 17 Sixteen studies 8 , 11 , 12 , 14 , 20 , 24 , 25 , 27 , 28 , 32 , 37 , 39 , 41 – 44 were of study good quality, and ten 9 , 10 , 13 , 17 , 18 , 26 , 31 , 34 , 36 , 38 were of fair study quality. VA care was better in 15 of these studies, 11 – 14 , 17 , 20 , 24 – 28 , 34 , 37 , 42 , 44 including 5 studies 11 , 25 , 34 , 37 , 42 comparing VA and VA-paid community care. Clinical quality or safety was equal or mixed between VA and non-VA care in 7 studies, 8 , 18 , 31 , 32 , 36 , 39 , 43 and worse in VA in 4 studies.…”

Section: Resultsmentioning

confidence: 99%

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Veterans Health Administration (VA) vs. Non-VA Healthcare Quality: A Systematic Review

et al. 2023

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Background The Veterans Health Administration (VA) serves Veterans in the nation’s largest integrated healthcare system. VA seeks to provide high quality of healthcare to Veterans, but due to the VA Choice and MISSION Acts, VA increasingly pays for care outside of its system in the community. This systematic review compares care provided in VA and non-VA settings, and includes published studies from 2015 to 2023, updating 2 prior systematic reviews on this topic. Methods We searched PubMed, Web of Science, and PsychINFO from 2015 to 2023 for published literature comparing VA and non-VA care, including VA-paid community care. Records were included at the abstract or full-text level if they compared VA medical care with care provided in other healthcare systems, and included clinical quality, safety, access, patient experience, efficiency (cost), or equity outcomes. Data from included studies was abstracted by two independent reviewers, with disagreements resolved by consensus. Results were synthesized narratively and via graphical evidence maps. Results Thirty-seven studies were included after screening 2415 titles. Twelve studies compared VA and VA-paid community care. Most studies assessed clinical quality and safety, and studies of access were second most common. Only six studies assessed patient experience and six assessed cost or efficiency. Clinical quality and safety of VA care was better than or equal to non-VA care in most studies. Patient experience in VA care was better than or equal to experience in non-VA care in all studies, but access and cost/efficiency outcomes were mixed. Discussion VA care is consistently as good as or better than non-VA care in terms of clinical quality and safety. Access, cost/efficiency, and patient experience between the two systems are not well studied. Further research is needed on these outcomes and on services widely used by Veterans in VA-paid community care, like physical medicine and rehabilitation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Veterans Health Administration (VA) vs. Non-VA Healthcare Quality: A Systematic Review

et al. 2023

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“…Referral patterns for VHA patients requiring genetics consultation vary by location. 34 Medical geneticists or genetic counselors are on staff at a limited number of major VHA medical centers, including those in Boston, MA, Houston, TX, and San Francisco, CA, West Haven, CT and West Los Angeles, CA. Over 80 VHA locations without an onsite genetic consultant have telehealth service agreements with the VA Genomic Medicine Service (GMS) based at the VA Salt Lake City Health Care System.…”

Section: Genetic Consultative Services At Vhamentioning

confidence: 99%

Introducing return of results in the Million Veteran Program: Design and pilot results of the MVP-ROAR Familial Hypercholesterolemia Study

Vassy,

Brunette,

et al. 2023

Preprint

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BackgroundAs a mega-biobank linked to a national healthcare system, the Million Veteran Program (MVP) can directly improve the health care and health outcomes of participants. Return of genetic research results at this scale presents challenges and complexities.MethodsTo determine the feasibility and outcomes of returning medically actionable genetic results to MVP participants, the program launched the MVP Return Of Actionable Results (MVP-ROAR) Study, with familial hypercholesterolemia (FH) as the exemplar actionable condition. The MVP-ROAR-FH Study consists of a completed pilot phase and an ongoing randomized clinical trial (RCT), in which MVP participants are recontacted and invited to receive clinical confirmatory gene sequencing testing and a telegenetic counseling intervention. The primary outcome of the RCT is 6-month change in low-density lipoprotein cholesterol (LDL-C) between participants receiving results at baseline and those receiving results after 6 months.ResultsNine MVP participants suspected to have a pathogenic variant inlow-density lipoprotein receptor(LDLR) enrolled in the single-arm pilot phase of the study; one was lost to follow-up prior to confirmatory testing. Clinical sequencing confirmed the pathogenic variant for 5 of the remaining 8 participants. Six-month ΔLDL-C among enrollees after the genetic counseling intervention was −37 mg/dL (95% CI: −12 to −61;p=0.03).ConclusionsWhile underscoring the importance of analytic validity and clinical confirmation of research results, the pilot phase of the MVP-ROAR-FH Study demonstrates the feasibility of a protocol to return genetic results to MVP participants and their providers. The ongoing RCT will contribute to understanding of how such a program might improve patient health care and outcomes.

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“…7,12 Although telehealth is an emerging and important tool in expanding access to genetic services overall, 13 there is also evidence that telehealth can widen racial and ethnic disparities with respect to genetic testing and evaluation, including within the VHA. 12 Additionally, there is evidence that older individuals and some subgroups of individuals experiencing barriers such as homelessness-populations over-represented among Veterans-face greater challenges in using telehealth services. 14,15 Genetics services are defined as a part of basic nursing practice in the published Scope and Standards of Clinical Genetics Nursing Practice, first published in 1998 by the American Nurses Association and the International Society of Nurses in Genetics (ISONG, updated in 2016).…”

Section: Introductionmentioning

confidence: 99%

On-Site Nurse-Led Cancer Genetics Program Increases Cancer Genetic Testing Completion in Black Veterans

Shevach

Aiello

Lynch

et al. 2023

JCO Oncology Practice

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PURPOSE Telegenetics services can expand access to guideline-recommended cancer genetic testing. However, access is often not distributed equitably to all races and ethnicities. We evaluated the impact of an on-site nurse-led cancer genetics service in a diverse Veterans Affairs Medical Center (VAMC) oncology clinic on likelihood of germline testing (GT) completion. METHODS We conducted an observational retrospective cohort study of patients who were referred for cancer genetics services at the Philadelphia VAMC between October 1, 2020, and February 28, 2022. We evaluated the association between genetics service (on-site v telegenetics) and likelihood of GT completion in a subcohort of new consults, excluding patients with prior consults and those referred for known history of germline mutations. RESULTS A total of 238 Veterans, including 108 (45%) seen on site, were identified for cancer genetics services during the study period, with the majority referred for a personal (65%) or family (26%) history of cancer. In the subcohort of new consults, 121 Veterans (54% self-identified race/ethnicity [SIRE]-Black), including 60 (50%) seen on site, were included in the analysis of germline genetic testing completion. In a univariate analysis, patients who were seen by the on-site genetics service had 3.2-fold higher likelihood of completing GT (relative risk, 3.22; 95% CI, 1.89 to 5.48) compared with the telegenetics service. In multivariable regression analysis, the on-site genetics service was associated with higher likelihood of GT completion, but this association was only statistically significant in SIRE-Black compared with SIRE-White Veterans (adjusted RR, 4.78; 95% CI, 1.53 to 14.96; P < .001; P-interaction of race × genetics service = .016). CONCLUSION An on-site nurse-led cancer genetics service embedded in a VAMC Oncology practice was associated with higher likelihood of germline genetic testing completion than a telegenetics service among self-identified Black Veterans.

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Demographic Differences Among US Department of Veterans Affairs Patients Referred for Genetic Consultation to a Centralized VA Telehealth Program, VA Medical Centers, or the Community

Abstract: This cross-sectional study assesses care coordination and equity of genetic care delivered by centralized telehealth and traditional genetic care models for US Department of Veteran Affairs patients.

Cited by 7 publications

References 32 publications

Veterans Health Administration (VA) vs. Non-VA Healthcare Quality: A Systematic Review

Veterans Health Administration (VA) vs. Non-VA Healthcare Quality: A Systematic Review

Introducing return of results in the Million Veteran Program: Design and pilot results of the MVP-ROAR Familial Hypercholesterolemia Study

On-Site Nurse-Led Cancer Genetics Program Increases Cancer Genetic Testing Completion in Black Veterans

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