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Promoting Cancer Genomics Best Practices through Surveillance, Education and Policy Change in the State of Michigan, 2008-2011

The MDCH Genomics Program, in collaboration with the CDC Office of Public Health Genomics, is identifying and promoting cancer genomics best practices for appropriate translation of cancer genetic tests and gene profiling tests into clinical and public health practice. Project goals include: 

 

1) Developing and implementing a model for surveillance of inherited cancers and use of relevant genetic tests
2) Identifying model provider education programs to increase use of appropriate screening, counseling and evidence-based genetic tests
3)  Identifying a model health insurance policy for BRCA1 & 2 cancer genetic testing

For an overview of the project, please view our presentation on the Cancer Control P.L.A.N.E.T. Research to Reality Cyber-Seminar series!

Methods:  
The core MDCH team includes a project director, coordinator, cancer genomics educator and two epidemiologists. In addition, we have identified the partners needed to 1) develop a surveillance system to monitor the use of genetic counseling and testing for BRCA1/2, and the use of genetic tests for colorectal cancer (Lynch Syndrome);  2) implement educational activities;  and 3) identify the need for health plan policy changes in relation to the US Preventive Services Task Force Guidelines for the use of BRCA testing. Multiple different activities will address each of these objectives. For further details, please see our logic model.
 

schematic 

This project's target population encompasses the entire state of Michigan and includes patients with or at increased risk for specific cancers, providers, health systems, and health insurance plans.  Evaluation is based on methods recommended by the Guide to Community Preventive Services, and is designed to demonstrate an increase from baseline measures. 

Expected Outcomes: 
After completion of the Cancer Genomics project, we anticipate the following outcomes related to surveillance, education and policy. 

Surveillance 

 

a)   Increased understanding of statewide mortality associated with hereditary breast/ovarian, colorectal and other HNPCC-related cancers 
b) A description of provider practices regarding the use of family history assessment, genetic counseling, and genetic testing in patients with cancer 
c)  An assessment of barriers and facilitators to cancer survivor knowledge, attitudes and use of family history, genetic counseling and testing 
d) Development of new methods for collecting data on the clinical use of BRCA1 & 2 genetic testing. 

Education 

 

a)   Increased use of USPSTF clinical practice guidelines for BRCA1 & 2 testing. 
b) Increased provider awareness about the validity, utility, harms, and benefits of HNPCC mismatch repair testing and gene expression profiling tests for breast cancer. 

Policy 

 

a)   An increased understanding of the current status of health insurance policies for BRCA1 & 2 genetic testing with respect to USPSTF guidelines 
b) An increased number (from baseline) of health insurance plans that have policies consistent with USPSTF clinical practice guidelines for BRCA 1 & 2 testing. 

Results:    
This genomics translation project is now in its third year of activity, with data analysis currently underway. Accomplishments to date include:
 

 

ü  Established partnerships with the state cancer registry, vital records, Michigan Cancer Consortium, Michigan Cancer Genetics Allianceall cancer genetics clinics with board certified genetics professional(s), a health plan champion, and Michigan Association of Health Plans.  
ü  Developed survey instruments and databases for collection of hospital medical record and genetics clinic data. 
ü  Analyzed historical cancer registry data 
ü  Collected baseline information on health plan policies for BRCA 1/2 counseling and testing 
ü   Developed and implemented a patient survey instrument to assess the barriers and facilitators to accessing clinical cancer genetic services and genetic testing by breast cancer survivors 
ü  Developed a patient survey instrument to assess follow-up measures, cancer diagnoses and treatment, insurance coverage for related services, and family notification of test results of patients BRCA positive patients with true negative patients 
ü   Created and disseminated the Cancer Family History Guide handheld clinical decision tool designed to identify patients at risk for Hereditary Breast and Ovarian Cancer syndrome (HBOC) or Lynch syndrome
ü  Created and piloted a unique provider education presentation aimed at increasing provider knowledge of inherited cancer risk, increasing provider confidence in collecting and evaluating family history and making medical recommendations
ü  Disseminated the Cancer Genetics Profile (2010) with facility-specific data reports to 107 hospitals and health systems within Michigan
ü  Completed over 1600 hospital chart reviews to collect data on provider practices regarding the use of family history, genetic counseling, and testing
ü  Established a statewide network of 12 clinical sites for collecting and sharing data on cancer genetic referrals and the use of genetic testing for BRCA ½
ü  Recognized and honored 7 Michigan health plans at key events for having written policies aligned with the USPSFT guidelines on "Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility"
ü  Held an educational session in December 2010 for Michigan Association of Health Plan members to highlight the USPSTF guidelines and other relevant information

Additional progress will be shared on this website in the future. For further information, please call 1-866-852-1247 or email Genetics@michigan.gov 

Michigan's Cancer Genomics project is supported by Cooperative Agreement #5U38GD000054 from the Centers for Disease Control and Prevention (CDC). The contents of this webpage are the sole responsibility of the authors and do not necessarily represent the official views of CDC. 




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