NSQIP Quality Benchmarking and Evaluation of Potential Bias Associated with Higher- or Lower-Risk Operation Case Mix.

BACKGROUND: To ensure validity and acceptance of NSQIP risk-adjusted benchmarking, it is important that adjustments adequately control for hospitals that vary in their proportions of lower- or higher-risk operations (combined risk for procedure and patient). This issue was addressed in separate empirical and simulation studies. STUDY DESIGN: For the empirical study, potential miscalibration bias favoring hospitals that do lower-risk operations or disfavoring hospitals that do higher-risk operations was evaluated for 14 modeled outcomes using NSQIP data. A determination was also made as to whether there was a relationship between mean hospital operation risk and benchmarking results (log odds ratio). In the simulation study of the same 14 outcomes, hospital benchmarked performance was evaluated when sampled cases were reconstituted to include either a larger proportion of lower-risk operations or a larger proportion of higher-risk operations. RESULTS: Miscalibration favoring either lower- or higher-risk operations was absent, as were important associations between operative risk and hospital log odds ratios (most model R 2 less than 0.01). In the simulation, there were no substantial changes in log odds ratios when greater percentages of either lower- or higher-risk operations were included in a hospital's sample (nonsignificant p values and effect sizes less than 0.1). CONCLUSIONS: These results should enhance NSQIP participants' confidence in the adequacy of NSQIP patient and procedure risk-adjustment methods. NSQIP participants may rely on benchmarking findings, and implement quality improvement efforts based on them, without concern that they are biased by a preponderance of lower or higher risk operations.

Recommended pre-test counseling points for noninvasive prenatal testing using cell-free DNA: a 2015 perspective.

Noninvasive prenatal testing (NIPT) using cell-free DNA is being offered to an increasing number of women. Comprehensive pre-test counseling is complicated by emerging information about the benefits and limitations of testing, as well as the potential to detect incidental findings. Genetic counselors are trained to facilitate informed decision-making; however, not all centers have access to these professionals. To aid in the informed consent process, we have summarized key points to be included in discussions with patients who are considering NIPT.

NIPT: current utilization and implications for the future of prenatal genetic counseling.

BACKGROUND: Non-invasive prenatal testing (NIPT) for select fetal trisomies became clinically available in 2011. When it was introduced, there were no recommendations from the major governing bodies in prenatal genetics regarding its incorporation. PURPOSE: We sought to determine how genetic counselors have incorporated NIPT into clinical practice and how NIPT has changed the informed consent process. METHODS: We distributed an anonymous, online survey to National Society of Genetic Counselors (NSGC) members in October 2012. RESULTS: There were 181 respondents who indicated they incorporated NIPT into their practice with the majority (94.1%) offering it to patients with high risk pregnancies. Of the respondents, 45.1% indicated that there should be a separate informed consent form for NIPT. Respondents indicated that a discussion about NIPT with a patient should highlight that it is a screening test, the detection rate is superior to that of maternal serum screening, it screens for specific conditions, and a positive NIPT result should be confirmed with a diagnostic test. CONCLUSION: Following data collection, the American Congress of Obstetricians and Gynecologists, the American College of Medical Genetics, and NSGC released practice guidelines surrounding NIPT. Our results demonstrate that most genetic counselors have been offering NIPT consistent with these guidelines.