Denial of Inpatient Genetic Testing: A Study on Outpatient Yield and Outcomes

Area of Science:

• Medical Genetics
• Pediatric Healthcare
• Health Services Research

Background:

• Genetic testing is vital for diagnosing pediatric conditions but faces cost barriers.
• Case management aims to balance patient access with institutional financial concerns.
• Data on inpatient vs. outpatient genetic testing yields and care denial impact is limited.

Purpose of the Study:

• To investigate the diagnostic yield of inpatient genetic testing based on approval status.
• To compare diagnostic yields between inpatient and outpatient genetic testing settings.
• To assess the impact of genetic testing on patient care and management.

Main Methods:

• Retrospective chart review of 1052 children receiving genetic consults between July 2018 and June 2023.
• Analysis of data including genetic testing recommendations, completion, results, and subsequent management.
• Statistical comparison of diagnostic yields and outcomes between approved and denied inpatient genetic testing groups, and outpatient follow-up.

Main Results:

• Patients with private insurance and no prematurity history were less likely to be approved for inpatient genetic testing.
• The outpatient genetic testing group demonstrated nearly double the diagnostic yield compared to the inpatient group.
• Management recommendations did not significantly differ between groups, irrespective of testing approval or setting.

Conclusions:

• Inclusion of genetic providers in reviewing inpatient genetic testing requests may enhance diagnostic yields and patient outcomes.
• Outpatient genetic testing shows a higher diagnostic yield, highlighting potential inefficiencies in inpatient approval processes.
• Optimizing genetic testing access and review is crucial for improving pediatric diagnostic accuracy and care.