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Abstract
Atherosclerotic cardiovascular disease is the leading cause of death globally. Despite its important risk of premature atherosclerosis and cardiovascular disease, familial hypercholesterolemia (FH) is still largely underdiagnosed worldwide. It is one of the most frequently inherited diseases due to mutations, for autosomal dominant forms, in either of the LDLR, APOB, and PCSK9 genes or possibly a few mutations in the APOE gene and, for the rare autosomal forms, in the LDLRAP1 gene. The discovery of the genes implicated in the disease has largely helped to improve the diagnosis and treatment of FH from the LDLR by Brown and Goldstein, as well as the introduction of statins, to PCSK9 discovery in FH by Abifadel et al., and the very rapid availability of PCSK9 inhibitors. In the last two decades, major progress has been made in clinical and genetic diagnostic tools and the therapeutic arsenal against FH. Improving prevention, diagnosis, and treatment and making them more accessible to all patients will help reduce the lifelong burden of the disease.
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Affiliation(s)
- Marianne Abifadel
- UMR1148, Inserm, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, F-75018 Paris, France.,Laboratory of Biochemistry and Molecular Therapeutics (LBTM), Faculty of Pharmacy, Pôle Technologie-Santé, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Catherine Boileau
- UMR1148, Inserm, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, F-75018 Paris, France.,Département de Génétique, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
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Jones LK, Strande NT, Calvo EM, Chen J, Rodriguez G, McCormick CZ, Hallquist MLG, Savatt JM, Rocha H, Williams MS, Sturm AC, Buchanan AH, Glasgow RE, Martin CL, Rahm AK. A RE-AIM Framework Analysis of DNA-Based Population Screening: Using Implementation Science to Translate Research Into Practice in a Healthcare System. Front Genet 2022; 13:883073. [PMID: 35692820 PMCID: PMC9174580 DOI: 10.3389/fgene.2022.883073] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: DNA-based population screening has been proposed as a public health solution to identify individuals at risk for serious health conditions who otherwise may not present for medical care. The clinical utility and public health impact of DNA-based population screening is a subject of active investigation. Geisinger, an integrated healthcare delivery system, was one of the first healthcare systems to implement DNA screening programs (MyCode Community Health Initiative (MyCode) and clinical DNA screening pilot) that leverage exome data to identify individuals at risk for developing conditions with potential clinical actionability. Here, we demonstrate the use of an implementation science framework, RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance), to conduct a post-hoc evaluation and report outcomes from these two programs to inform the potential impact of DNA-based population screening. Methods: Reach and Effectiveness outcomes were determined from the MyCode research program, while Adoption and Implementation outcomes were measured using the clinical DNA screening pilot. Reach was defined as the number of patients who were offered and consented to participate in MyCode. Effectiveness of DNA screening was measured by reviewing MyCode program publications and synthesizing findings from themes. Adoption was measured by the total number of DNA screening tests ordered by clinicians at the clinical pilot sites. Implementation was assessed by interviewing a subset of clinical pilot clinicians about the deployment of and recommended adaptations to the pilot that could inform future program dissemination. Results:Reach: As of August 2020, 68% (215,078/316,612) of individuals approached to participate in the MyCode program consented. Effectiveness: Published evidence reported from MyCode demonstrates that DNA screening identifies at-risk individuals more comprehensively than clinical ascertainment based on phenotypes or personal/family history. Adoption: From July 2018 to June 2021, a total of 1,026 clinical DNA screening tests were ordered by 60 clinicians across the three pilot clinic sites. Implementation: Interviews with 14 clinicians practicing at the pilot clinic sites revealed motivation to provide patients with DNA screening results and yielded future implementation strategies. Conclusion: The RE-AIM framework offers a pragmatic solution to organize, analyze, and report outcomes across differently resourced and designed precision health programs that include genomic sequencing and return of clinically actionable genomic information.
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Affiliation(s)
- Laney K. Jones
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
- Heart and Vascular Institute, Geisinger, Danville, PA, United States
| | - Natasha T. Strande
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA, United States
| | - Evan M. Calvo
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
| | - Jingheng Chen
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | | | - Juliann M. Savatt
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA, United States
| | - Heather Rocha
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
| | - Marc S. Williams
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
| | - Amy C. Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
- Heart and Vascular Institute, Geisinger, Danville, PA, United States
| | - Adam H. Buchanan
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
| | - Russell E. Glasgow
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Christa L. Martin
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA, United States
| | - Alanna Kulchak Rahm
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
- *Correspondence: Alanna Kulchak Rahm,
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Jones LK, Brownson RC, Williams MS. Applying implementation science to improve care for familial hypercholesterolemia. Curr Opin Endocrinol Diabetes Obes 2022; 29:141-151. [PMID: 34839326 PMCID: PMC8915991 DOI: 10.1097/med.0000000000000692] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Improving care of individuals with familial hypercholesteremia (FH) is reliant on the synthesis of evidence-based guidelines and their subsequent implementation into clinical care. This review describes implementation strategies, defined as methods to improve translation of evidence into FH care, that have been mapped to strategies from the Expert Recommendations for Implementing Change (ERIC) compilation. RECENT FINDINGS A search using the term 'familial hypercholesterolemia' returned 1350 articles from November 2018 to July 2021. Among these, there were 153 articles related to improving FH care; 1156 were excluded and the remaining 37 were mapped to the ERIC compilation of strategies: assess for readiness and identify barriers and facilitators [9], develop and organize quality monitoring systems [14], create new clinical teams [2], facilitate relay of clinical data to providers [4], and involve patients and family members [8]. There were only 8 of 37 studies that utilized an implementation science theory, model, or framework and two that explicitly addressed health disparities or equity. SUMMARY The mapping of the studies to implementation strategies from the ERIC compilation provides a framework for organizing current strategies to improve FH care. This study identifies potential areas for the development of implementation strategies to target unaddressed aspects of FH care.
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Affiliation(s)
- Laney K. Jones
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Ross C. Brownson
- Department of Surgery (Division of Public Health Sciences) and Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
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