P614: Incorporating genomic medicine to improve risk stratification in severe hypercholesterolemia: Comparing implementation outcomes from two health systems

Introduction: Swiftly evolving innovations in genomics technologies have fueled necessity for genetic services, creating an ever-widening gap between the need for and the availability of trained providers, namely geneticists and genetic counselors, to meet the growing demand.The Indiana University School of Medicine (IUSM), affiliated with a large academic medical center with a robust Department of Medical and Molecular Genetics, is not immune to the challenges of the persistent genetics provider shortfall.Endeavoring to advance the IUSM Precision Health Initiative (PHI), the Genetics leadership team recognized that advanced practice providers (APPs), specifically nurse practitioners (NPs) and physician assistants (PAs), functioning at the top of their education, training, and license, represent a potentially large pool of yet to be trained genetics providers capable of addressing health inequities through improved access to genetics specialty care in inpatient and outpatient environments.One academic goal of the IUSM-PHI is the creation of new educational programs.Development and implementation of an evidence-based APP education and training was deemed an innovative strategy particularly well-suited to achieve that goal, increasing the capacity to promote equitable access and optimal patient outcomes through safe, high quality genetics health care.Methods: An interprofessional Genetics NP/PA Project Team collaborated monthly and included a dual-specialty, doctoral-prepared advanced practice nurse as the project lead; 2 board-certified medical geneticists; and a licensed/certified genetic counselor.Key implementation science frameworks guided the development and implementation of the Genetics APP Education and Training Program.A thorough review of the literature and state licensing agency requirements was conducted to identify best practices and regulatory scope of practice.Insights from subject matter experts within the larger IUSM team remain invaluable.Equally important, myriad APPs currently engaged as genetics providers in United States were informally queried and provided unique perspectives and lessons learned about the useful and challenging elements of their onboarding and training experiences in genetics.Results: Teamwork facilitated the development and implementation within 10 months.The hallmark deliverable was a 12-month evidence-based education and training program comprised of didactic and clinical components, designed to upskill licensed NPs and PAs to serve as genetics providers within an interprofessional team in a variety of care settings.The creation of a comprehensive toolkit comprised of important supporting documents includes a genetics NP/PA job description, collaborative agreement, standardized procedures, onboarding checklist and resources, and clinical competencies.Specific outcomes of interest are pending conclusion of mixed-methods, educational intervention study with oversight by the IU institutional review board.Analysis of validated assessments to compare pre and post intervention NP/PA genetics competence, confidence, retention, and participant experience will be conducted.Preliminary outcomes include the hire and onboarding of 3 genetics NPs within 8 months of implementation.One NP has successfully completed the genetics educational intervention with emphasis in inpatient pediatric settings (NICU, PICU, and CVICU).Two NPs are more than halfway through the educational intervention focused on medical genetics in ambulatory care.Feedback from the genetics NP trainees and the interprofessional genetics team is largely positive.Following successful implementation for the APPs, a new Genetics Track was added to the well-established suite of Postgraduate APP Fellowships at Indiana University Health. Conclusion:The structured genetics APP education and training toolkit developed and implemented at IUSM has the potential to serve as an exemplar for clinical practice education and training leading to improved access to genetics specialty care.Our team anticipates easy adaptability to a variety of genetics care settings.Along with the outcomes of interest referenced previously, future inquiry to evaluate longitudinal metrics such as impact on patient access to, quality of, and reimbursement for genetic specialty services; and interprofessional team satisfaction with integration of genetics APPs is warranted.