Table 1.

UGTI Quality Improvement Interventions

Name of Intervention	Original UGTI Intervention Description15	County Hospital UGTI Adaptations	Date Initiated	Intervention Metrics	Duration
Integrated Genetic Counseling (IGC)	• Integrate genetic counselor in Gyn One clinic • Optimize GC schedule • Standardized urgent appointment request process	• Optimized scheduling referral criteria: diagnosis of HGOC, diagnosis of EC with abnormal tumor studies, or cascade testing • 4 appointments per GC clinic: 2 morning clinics per month (1st and 3rd Tuesdays) • No urgent appointments • Spanish interpretation provided by telephone	6/30/2015	• Frequency of clinic (dates) • Numbers of GC appointments completed, canceled, no-show, or not used • Time between cancer diagnosis and completed GC appointment	Ongoing
Physician education	Physicians attend national meetings and conferences discussing hereditary cancer. Genetic counselors provide education as needed.	• Direct communication by genetic counselor to physicians rather than conference/event • Stakeholder meeting to review tumor testing process, billing, timelines, and expectations with pathology and Gyn One staff prior to launching provider email notifications for patients with EC	12/1/2015	• Frequency of meetings for education	Ongoing (as needed)
Clinic patient tracking	Research data coordinator collected data from clinic schedules and the medical record to determine whether patients received GC/GT.	• Genetic counselor performed clinic tracking during clinic time when patients canceled/no-showed appointments or when no appointments scheduled. • Clinic tracking included retrospective collection of patients, with first date of new patient presentation to Gyn One clinic of 1/1/2015, then continued prospectively • Included tracking of patients with HGOC and EC	1/1/2016	• Frequency of clinic review (quarterly)	Ongoing
Assisted Genetic Counseling Referral (AGCR)	Electronic referral to GC drafted for patients who have not had GC/GT.	• Medical record system prohibited drafting of electronic referrals to Gyn One clinic GC • All notifications of patients eligible for GC/GT were sent via email • Notifications sent by genetic counselor to the physician and clinic care team • Notifications were sent for patients with HGOC to have GC, patients with EC to have tumor testing • APRN tracked EC tumor testing requests and triaged patient referrals to GC per results	1/1/2016	• Frequency of notifications (quarterly) • Number of cases identified for notification • Outcomes of notifications	Ongoing
Provider email notifications	Research data coordinator and genetic counselor notify physician/care team of upcoming patients not previously referred for GC/GT.

Abbreviations: Gyn One: gynecologic oncology, GC: Genetic counseling, HGOC: high-grade, non-mucinous epithelial ovarian, fallopian tube, and primary peritoneal cancers, EC: endometrial cancer, GT: genetic testing, APRN: Advanced Practice Registered Nurse