Development, implementation and evaluation of protocols for the management of women and children in South Texas who are at risk for genetic and other birth disorders

Objectives: The purpose of this project was to improve genetic service provision for the unserved patients in Texas Public Health Region VIII by providing primary care providers with the skills necessary to participate in the comprehensive care of patients at risk for genetic and other birth disorders. Methods: 1,737 patient charts were reviewed from the Maternity, Pediatric and Family Planning clinics of 14 sites, 2 Federally Qualified Community Health centers and 12 Maternal and Child Health primary care clinics. From this review, 10 high-frequency genetic risk indicators were identified. Protocols in the form of decision flow charts were developed, and primary care providers were educated about the use and reasoning for the flow of the protocols. Results: One year after protocol implementation, 1,713 new records were reviewed. Before protocol implementation, 12.6% of patients with an indicator of high risk were offered an appropriate referral. After implementation, 45.9% of patients with a high-risk indicator were offered appropriate referral (χ² = 39.76, p < 0.0001). Conclusions: These findings suggest that the protocol format and content provide an effective and efficient method of identifying and managing patients with risk factors for genetic and other birth disorders.