Title: 14.4 A Collaborative Psychiatric-Genetics Inpatient Care Delivery Model Improves Access to Clinical Genetic Evaluation, Testing, and Diagnosis for Patients With Neurodevelopmental Disorders
Abstract: ObjectivesThe current American College of Medical Genetics and Genomics (ACMG) guidelines recommend genetic testing for all patients with neurodevelopmental disorders (NDDs) including ASD, intellectual disability, and global developmental delay. Even with strong evidence-based recommendations, there are many patients with NDDs who do not receive a clinical genetics evaluation or diagnostic testing for a variety of reasons, often complicated by a general lack of access to quality medical care for children with NDDs. Child and adolescent psychiatrists who work with patients with NDDs can find themselves in a unique position in terms of longitudinal care for patients with co-occurring mental health disorders. Child and adolescent psychiatrists may be the most consistent point of contact with the healthcare system for those with NDDs requiring long-term psychiatric medication management.MethodsTo improve access to a genetics evaluation for patients with NDDs, our team created a collaborative psychiatric-genetics inpatient consultation service and psychiatric-genetics outpatient clinic with the goal to improve care delivery. Two years after the launch of this pilot program, we performed a retrospective chart review to assess the accessibility.ResultsWe analyzed wait time to genetics appointments for patients referred from neurodevelopmental psychiatrists for evaluation and found that the wait time decreased from 460 days to 26 days, and the no-show rate dropped from 32% to 1% after the collaborative clinic implementation. The secondary outcomes measured included diagnostic yield in both cohorts (which improved from 32% to 44% after collaboration) and yield of test type (exome-based studies were 4 times as likely to identify a diagnosis over microarray, when sent concurrently). Finally, we analyzed changes in care or implementation of syndrome-specific management after a new diagnosis was conferred (88% of newly diagnosed patients had syndrome-specific medical management changes).ConclusionsInpatient care delivery of clinical genetics evaluation and testing is a novel concept, and to our knowledge, we are the first to report on the model of embedding a clinical geneticist into psychiatric acute inpatient care delivery and outpatient psychiatry clinics, with demonstrated improvements in health outcomes.GS, ND, ASD ObjectivesThe current American College of Medical Genetics and Genomics (ACMG) guidelines recommend genetic testing for all patients with neurodevelopmental disorders (NDDs) including ASD, intellectual disability, and global developmental delay. Even with strong evidence-based recommendations, there are many patients with NDDs who do not receive a clinical genetics evaluation or diagnostic testing for a variety of reasons, often complicated by a general lack of access to quality medical care for children with NDDs. Child and adolescent psychiatrists who work with patients with NDDs can find themselves in a unique position in terms of longitudinal care for patients with co-occurring mental health disorders. Child and adolescent psychiatrists may be the most consistent point of contact with the healthcare system for those with NDDs requiring long-term psychiatric medication management. The current American College of Medical Genetics and Genomics (ACMG) guidelines recommend genetic testing for all patients with neurodevelopmental disorders (NDDs) including ASD, intellectual disability, and global developmental delay. Even with strong evidence-based recommendations, there are many patients with NDDs who do not receive a clinical genetics evaluation or diagnostic testing for a variety of reasons, often complicated by a general lack of access to quality medical care for children with NDDs. Child and adolescent psychiatrists who work with patients with NDDs can find themselves in a unique position in terms of longitudinal care for patients with co-occurring mental health disorders. Child and adolescent psychiatrists may be the most consistent point of contact with the healthcare system for those with NDDs requiring long-term psychiatric medication management. MethodsTo improve access to a genetics evaluation for patients with NDDs, our team created a collaborative psychiatric-genetics inpatient consultation service and psychiatric-genetics outpatient clinic with the goal to improve care delivery. Two years after the launch of this pilot program, we performed a retrospective chart review to assess the accessibility. To improve access to a genetics evaluation for patients with NDDs, our team created a collaborative psychiatric-genetics inpatient consultation service and psychiatric-genetics outpatient clinic with the goal to improve care delivery. Two years after the launch of this pilot program, we performed a retrospective chart review to assess the accessibility. ResultsWe analyzed wait time to genetics appointments for patients referred from neurodevelopmental psychiatrists for evaluation and found that the wait time decreased from 460 days to 26 days, and the no-show rate dropped from 32% to 1% after the collaborative clinic implementation. The secondary outcomes measured included diagnostic yield in both cohorts (which improved from 32% to 44% after collaboration) and yield of test type (exome-based studies were 4 times as likely to identify a diagnosis over microarray, when sent concurrently). Finally, we analyzed changes in care or implementation of syndrome-specific management after a new diagnosis was conferred (88% of newly diagnosed patients had syndrome-specific medical management changes). We analyzed wait time to genetics appointments for patients referred from neurodevelopmental psychiatrists for evaluation and found that the wait time decreased from 460 days to 26 days, and the no-show rate dropped from 32% to 1% after the collaborative clinic implementation. The secondary outcomes measured included diagnostic yield in both cohorts (which improved from 32% to 44% after collaboration) and yield of test type (exome-based studies were 4 times as likely to identify a diagnosis over microarray, when sent concurrently). Finally, we analyzed changes in care or implementation of syndrome-specific management after a new diagnosis was conferred (88% of newly diagnosed patients had syndrome-specific medical management changes). ConclusionsInpatient care delivery of clinical genetics evaluation and testing is a novel concept, and to our knowledge, we are the first to report on the model of embedding a clinical geneticist into psychiatric acute inpatient care delivery and outpatient psychiatry clinics, with demonstrated improvements in health outcomes.GS, ND, ASD Inpatient care delivery of clinical genetics evaluation and testing is a novel concept, and to our knowledge, we are the first to report on the model of embedding a clinical geneticist into psychiatric acute inpatient care delivery and outpatient psychiatry clinics, with demonstrated improvements in health outcomes.
Publication Year: 2022
Publication Date: 2022-10-01
Language: en
Type: article
Indexed In: ['crossref']
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