# Precision Medicine Care Coordination in the Veterans Health Administration

> **NIH VA I01** · VETERANS AFFAIRS MED CTR SAN FRANCISCO · 2021 · —

## Abstract

Background: Precision medicine is an innovative approach that takes into account individual genetic
differences to inform personalized decisions that can improve diagnosis, prognosis, risk assessment, treatment
and disease prevention. Genetic services, including genetic testing and genetic consultation are fundamental
to precision medicine. Genetic services have not yet been systematically adopted in many Department of
Veterans Affairs (VA) facilities because of their complexity, the limited genetics knowledge and expertise of
clinicians, and organizational barriers to utilization. Nonetheless, the demand for precision medicine within the
VA is increasing, and understanding optimal care arrangements for common referral reasons for genetic
consultation will be crucial to planning for high-quality and high-value precision medicine for our Veterans.
 There is substantial variability in the type of genetic consultation available (e.g., cancer, neuro- or
reproductive genetics), the expected role of the genetic consultant (i.e., diagnostic, procedural or care
management) and in the care arrangements for these consultations in the VA (i.e., care model, mode of
delivery and VA or non-VA care). Having different options for care arrangements for precision medicine can be
beneficial, but only if the care arrangements are matched to the needs and preferences of both patients and
the referring providers, and result in safe, effective and efficient care coordination. However, currently the
variation in care arrangements for precision medicine in the VHA depends on available local resources, such
as genetics expertise on-site or available through a telehealth service agreement, rather than care
arrangements that are flexible and congruent with patient and provider needs and preferences.
 Objectives: The goal of this VA HSR&D IIR proposal is to evaluate care coordination for precision
medicine, including the care coordination approaches and activities and their effects according to available
care arrangements for common reasons for genetic consultation in the VA. We will conduct the following aims:
Aim 1. Describe the precision medicine care coordination approaches and activities at VA facilities according
to the care arrangement (i.e., model, mode of delivery, and setting), including: the structures of care that
facilitate or hinder referral for genetic consultation, referral reasons, referral volume, expected role of the
consultant, and successful completion of genetic consults using data extracted from the Corporate Data
Warehouse. Aim 2. Describe the effects of care coordination approaches and activities for patients who have
completed a genetic consult according to the care arrangement, including: (a) genetic testing uptake and (b)
extent of health care utilization (e.g., uptake of procedures, imaging, treatment) as recommended by the
consulting clinician. Aim 3. Characterize the contextual factors (patient, provider, and inner and outer setting)
influencin...

## Key facts

- **NIH application ID:** 10308529
- **Project number:** 5I01HX002278-04
- **Recipient organization:** VETERANS AFFAIRS MED CTR SAN FRANCISCO
- **Principal Investigator:** Marcia McGory Russell
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-02-01 → 2021-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10308529

## Citation

> US National Institutes of Health, RePORTER application 10308529, Precision Medicine Care Coordination in the Veterans Health Administration (5I01HX002278-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10308529. Licensed CC0.

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