Date of Award

12-2022

Degree Name

Doctor of Philosophy

Department

Evaluation

First Advisor

David Hartmann, Ph.D.

Second Advisor

Brandon Youker, Ph.D.

Third Advisor

Donald Black, M.D.

Keywords

Community context, diffusion of innovations, evaluation, framework, pharmacogenomics, translation

Abstract

Translation, in the context of medical research, is a process that describes how knowledge and innovation move and change into real world applications and outcomes. This study explores the translation of a medical innovation, pharmacogenomics (PGx), from research into clinical practice using the perspectives of medical providers in a community setting. PGx is the influence of a person’s genetics on drug response. Despite being available for over a decade, PGx testing is not widely adopted. Prior research primarily examined PGx translation in large academic medical centers, but not much is known about it in community practice settings. A better understanding of the PGx translation process and barriers in this context is needed to improve its translation and aid in implementation program planning and evaluation.

This exploratory study uses the Diffusion of Innovations (DOI) framework to guide organization and analysis. Sampling is purposive, to capture perspectives from medical providers more likely to use PGx. The specialties of internal medicine, hospital medicine, medicinepediatrics, family medicine, pediatrics, cardiology, oncology and psychiatry are included. The method used for data collection is a qualitative, one-on-one structured interview, due to the indepth information sought. The primary analytic strategy is directed content analysis, and DOI acts as a guide for question organization and for interpretation of responses.

Twenty-two medical providers were interviewed—21 physicians and one nurse practitioner. Results of the interviews show that more than half (64%) of the participants have a financial connection to the hospital, either by hospital ownership of their practice or by a services agreement with the hospital. Since many community practices have this connection, providers describe being impacted by decisions the hospital makes with respect to what is available for ordering and prescribing. They are hampered by the lack of EHR integration of and financial support for PGx testing. Additionally, for those able to order the tests, there is inconsistency in ordering process and results reporting depending on which testing company is used.

Two overarching revelations emerged from the study. One is that decisions about PGx adoption in a community context are, in many cases, practice group consensus decisions or hospital decisions. The second is that the provider’s connection to the hospital plays a larger role in adoption of lab tests, such as PGx, than in adoption of medications. Hospital adoption of PGx testing is a significant factor in its translation in the community practice setting. The use of a DOI framework to guide research into the structure and dynamics of a local healthcare system prior to developing an implementation program or conducting an evaluation helps distinguish which influences carry the greatest value. Evaluators engaging in medical research implementation and evaluation are uniquely positioned to extend their practice to community settings and play a role in improving PGx translation.

Access Setting

Dissertation-Open Access

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