Adoption of a clinical pharmacogenomics implementation program during outpatient care–initial results of the University of Chicago “1,200 Patients Project”

Authors

  • Peter H. O'Donnell,

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    • Peter H. O'Donnell, M.D., is an Assistant Professor of Medicine and principal investigator of The 1,200 Patients Project at The University of Chicago. He is also Associate Director for Clinical Implementation in The University of Chicago Center for Personalized Therapeutics.
  • Keith Danahey,

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    • Keith Danahey, M.S., is a senior software developer specializing in algorithms and large data sets. After earning a Master of Science in Computer Information Systems, he left algorithmic trading to use his skills for the greater good in the healthcare field.
  • Michael Jacobs,

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    • Michael Jacobs, B.S., has worked as a research assistant in the Center for Personalized Therapeutics at The University of Chicago for over a year.
  • Nisha R. Wadhwa,

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    • Nisha R. Wadhwa, B.S., a member of the University of Chicago Pritzker School of Medicine class of 2016, works in Dr. O'Donnell's research group in The Center for Personalized Therapeutics at The University of Chicago as part of the Scholarship and Discovery component of her medical education.
  • Shennin Yuen,

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    • Shennin Yuen, B.S., worked as a research assistant in The Center for Personalized Therapeutics at The University of Chicago during the time of data collection.
  • Angela Bush,

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    • Angela Bush, B.S., worked as a research assistant in The Center for Personalized Therapeutics at The University of Chicago during the time of data collection.
  • Yasmin Sacro,

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    • Yasmin Sacro, M.D., is an Assistant Professor of Medicine at The University of Chicago specializing in primary care.
  • Matthew J. Sorrentino,

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    • Matthew J. Sorrentino, M.D., is a Professor of Medicine and Associate Director of the Bucksbaum Institute for Clinical Excellence at The University of Chicago. He is a practicing cardiologist, with expertise and research interests in treating hyperlipidemia, hypertension, and coronary artery disease.
  • Mark Siegler,

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    • Mark Siegler, M.D., the Lindy Bergman Distinguished Service Professor of Medicine and Director of the MacLean Center for Clinical Medical Ethics at The University of Chicago, is the Executive Director of the Bucksbaum Institute for Clinical Excellence. He is a practicing physician in internal medicine.
  • William Harper,

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    • William Harper, M.D., is Medical Director of the Program for Personalized Health and Prevention at The University of Chicago. He is a practicing internist with an interest in the optimization of patient care.
  • Andrea Warrick,

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    • Andrea Warrick, B.S., is a molecular technologist at the Knight Diagnostic Laboratories of the Oregon Health & Science University.
  • Soma Das,

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    • Soma Das, Ph.D., is Director of the Clinical Molecular Genetics Laboratory in The University of Chicago's Department of Human Genetics.
  • Don Saner,

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    • Don Saner, M.S., is Director of Clinical and Translational Informatics in the Center for Research Informatics at The University of Chicago.
  • Christopher L. Corless,

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    • Christopher L. Corless, M.D., Ph.D., is Executive Director and Chief Medical Officer for Knight Diagnostic Laboratories at The Oregon Health & Science University.
  • Mark J. Ratain

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    • Mark J. Ratain, M.D., is the Leon O. Jacobson Professor of Medicine and Director of The Center for Personalized Therapeutics at The University of Chicago. He is also co-PI of the Pharmacogenomics of Anticancer Agents Research (PAAR) Group at The University of Chicago.

  • Conflict of interest disclosure: M.J.R. is a coinventor holding patents related to pharmacogenetic diagnostics and receives royalties related to UGT1A1 genotyping. No royalties are received from the genotyping performed in this study.
  • * Correspondence to: Peter H. O'Donnell, M.D., 5841 S. Maryland Avenue, MC 2115, Chicago, IL 60637. E-mail: podonnel@medicine.bsd.uchicago.edu

Abstract

Pharmacogenomic testing is viewed as an integral part of precision medicine. To achieve this, we originated The 1,200 Patients Project which offers broad, preemptive pharmacogenomic testing to patients at our institution. We analyzed enrollment, genotype, and encounter-level data from the first year of implementation to assess utility of providing pharmacogenomic results. Results were delivered via a genomic prescribing system (GPS) in the form of traffic lights: green (favorable), yellow (caution), and red (high risk). Additional supporting information was provided as a virtual pharmacogenomic consult, including citation to relevant publications. Currently, 812 patients have participated, representing 90% of those approached; 608 have been successfully genotyped across a custom array. A total of 268 clinic encounters have occurred at which results were accessible via the GPS. At 86% of visits, physicians accessed the GPS, receiving 367 result signals for medications patients were taking: 57% green lights, 41% yellow lights, and 1.4% red lights. Physician click frequencies to obtain clinical details about alerts varied according to color severity (100% of red were clicked, 72% yellow, 20% green). For 85% of visits, clinical pharmacogenomic information was available for at least one drug the patient was taking, suggesting relevance of the delivered information. We successfully implemented an individualized health care model of preemptive pharmacogenomic testing, delivering results along with pharmacogenomic decision support. Patient interest was robust, physician adoption of information was high, and results were routinely utilized. Ongoing examination of a larger number of clinic encounters and inclusion of more physicians and patients is warranted. © 2014 Wiley Periodicals, Inc.

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