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首页> 外文期刊>BMC Medical Genomics >A dynamic systems view of clinical genomics: a rich picture of the landscape in Australia using a complexity science lens
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A dynamic systems view of clinical genomics: a rich picture of the landscape in Australia using a complexity science lens

机译：临床基因组学的动态系统视图：使用复杂性科学镜头在澳大利亚的丰富图片

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Clinical genomics represents a paradigm shifting change to health service delivery and practice across many conditions and life-stages. Introducing this complex technology into an already complex health system is a significant challenge that cannot be managed in a reductionist way. To build robust and sustainable, high quality delivery systems we need to step back and view the interconnected landscape of policymakers, funders, managers, multidisciplinary teams of clinicians, patients and their families, and health care, research, education, and philanthropic institutions as a dynamic whole. This study holistically mapped the landscape of clinical genomics within Australia by developing a complex graphic: a rich picture. Using complex systems theory, we then identified key features, challenges and leverage points of implementing clinical genomics. We used a multi-stage, exploratory, qualitative approach. We extracted data from grey literature, empirical literature, and data collected by the Australian Genomic Health Alliance. Nine key informants working in clinical genomics critiqued early drafts of the picture, and validated the final version. The final graphic depicts 24 stakeholder groups relevant to implementation of genomics into Australia. Clinical genomics lies at the intersection of four nested systems, with interplay between government, professional bodies and patient advocacy groups. Barriers and uncertainties are also shown. Analysis using complexity theory showed far-reaching interdependencies around funding, and identified unintended consequences. The rich picture of the clinical genomic landscape in Australia is the first to show key stakeholders, agencies and processes and their interdependencies. Participants who critiqued our results were instantly intrigued and engaged by the graphics, searching for their place in the whole and often commenting on insights they gained from seeing the influences and impacts of other stakeholder groups on their own work. Funding patterns showed unintended consequences of increased burdens for clinicians and inequity of access for patients. Showing the system as a dynamic whole is the only way to understand key drivers and barriers to largescale interventions.
机译：临床基因组学代表了在许多条件和生命阶段的卫生服务交付和练习的范式转变变化。将这种复杂技术介绍到已经复杂的健康系统中是一个重大挑战，不能以还原侦查方式管理。为了构建强大和可持续的，高质量的送货系统，我们需要退后一步，并查看政策制定者，资助者，经理，临床医生，患者及其家庭的多学科团队，以及保健，研究，教育和慈善机构的互联景观。动态整体。本研究通过开发复杂的图形来全身映射澳大利亚临床基因组学的景观：丰富的图片。使用复杂的系统理论，我们确定了实施临床基因组学的关键特征，挑战和利用点。我们使用了多级，探索性，定性的方法。我们从灰色文献，经验文献和澳大利亚基因组健康联盟收集的数据提取数据。在临床基因组学中工作的九名重点线人批评图片的早期草稿，并验证了最终版本。最终的图形描绘了与实施基因组学到澳大利亚有关的24个利益相关者群体。临床基因组学位于四个嵌套系统的交叉点，政府，专业机构和患者倡导群体之间的相互作用。还显示了障碍和不确定性。使用复杂性理论的分析显示资金周围的相互依赖性，并确定了意外后果。澳大利亚临床基因组景观的丰富图片是第一个显示关键利益相关者，机构和流程及其相互依存的景观。批评我们的结果的参与者被图形瞬间兴致和从事，在整体上寻找他们的位置，并经常评论他们从看到其他利益相关者群体对自己工作的影响和影响。资金模式显示出对临床医生的负担增加和患者的不公平的意外后果。显示系统作为动态整体是了解钥匙驱动程序和障碍的唯一方法。

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