Promoting appropriate genetic testing: the impact of a combined test review and consultative service

Genet Med. 2017 Sep;19(9):1049-1054. doi: 10.1038/gim.2016.219. Epub 2017 Jan 26.


Purpose: Genetic test misorders can adversely affect patient care. However, little is known about the types of misorders and the overall impact of a utilization management (UM) program on curbing misorders. This study aimed to identify different types of misorders and analyze the impact of a combined test review and consultative service on reducing misorders over time.

Methods: Selected genetic tests were systematically reviewed between January and December 2015 at Stanford Health Care. Misorders were categorized into five types: clerical errors, redundant testing, better alternatives, controversial, and uncategorized. Moreover, consultations were offered to help clinicians with test selection.

Results: Of the 629 molecular test orders reviewed, 13% were classified as misorders, and 7% were modified or canceled. Controversial misorders constitute the most common type (42%); however, unlike the other misorder types, they were negligibly affected by test review. Simultaneously, 71 consults were received. With the introduction of the UM program, genetic test misorders went from 22% at baseline to 3% at the end of the year.

Conclusion: Our results show that the combined approach of test review and consultative service effectively reduced misorders over time and suggest that a UM program focused on eliminating misorders can positively influence health-care providers' behaviors.Genet Med advance online publication 26 January 2017.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Genetic Testing* / methods
  • Genetic Testing* / standards
  • Health Promotion*
  • Health Services Misuse
  • Humans
  • Referral and Consultation / standards