Provision of Genetic Testing and Counseling Services in American Hospitals

Introduction: Provision of genetic testing and counseling services (GT-GC) is facilitated by the adoption of clinical guidelines but limited by health insurance coverage and reimbursement policies. There is limited knowledge about the organizational factors influencing the provision of GT-GC among American hospitals.

Methods: The 2012 American Hospital Association (AHA) Annual Survey database was used to identify organizational factors associated with the provision of GT-GC. A logistic regression analysis was performed to predict the likelihood of the provision of GT-GC. Descriptive and inferential analyses were computed and reported using SPSS™ v22.

Results: We used data from 5,328 US hospitals. General factors associated with the provision of GT-GC were hospital location and ownership. The logistic regression model showed that organizational factors such as the provision of technology-intensive clinical services; radiotherapy (OR 3.88;CI 2.68-5.66), transplant (OR 3.04; CI 2.23-4.14), oncology (OR 2.32; CI 1.08-5.00), Alzheimer’s Center (OR 1.78; CI 1.24-2.55); along with the availability of trained personnel (Nurse-to-bed ratio OR 1.27; CI 1.01-1.59) were strongly associated with the provision of GT-GC services. Provision of GT-GC was, however, independent of the teaching status of the hospital and there were no significant differences between adult and pediatric hospitals.

Conclusions: This study shows the strength of the association between the availability of technology-intensive clinical services and skilled personnel with the provision of GT-GC services beyond those factors traditionally analyzed. Strengthening technological and personnel infrastructure along with improvements in health policies are key to fostering the provision of genetic testing and counseling services.