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Quality Assurance in Molecular Genetic Testing Laboratories
Margaret M. McGovern, MD, PhD;
Marta O. Benach;
Sylvan Wallenstein, PhD;
Robert J. Desnick, PhD, MD;
Richard Keenlyside, MD, MS
JAMA. 1999;281:835-840.
Context Specific regulation of laboratories performing molecular genetic tests may be needed to ensure standards and quality assurance (QA) and safeguard patient rights to informed consent and confidentiality. However, comprehensive analysis of current practices of such laboratories, important for assessing the need for regulation and its impact on access to testing, has not been conducted.
Objective To collect and analyze data regarding availability of clinical molecular genetic testing, including personnel standards and laboratory practices.
Design A mail survey in June 1997 of molecular genetic testing laboratory directors and assignment of a QA score based on responses to genetic testing process items.
Setting Hospital-based, independent, and research-based molecular genetic testing laboratories in the United States.
Participants Directors of molecular genetic testing laboratories (n=245; response rate, 74.9%).
Main Outcome Measure Laboratory process QA score, using the American College of Medical Genetics Laboratory Practice Committee standards.
Results The 245 responding laboratories reported availability of testing for 94 disorders. Personnel qualifications varied, although all directors had doctoral degrees. The mean QA score was 90% (range, 44%-100%) with 36 laboratories (15%) scoring lower than 70%. Higher scores were associated with test menu size of more than 4 tests (P=.01), performance of more than 30 analyses annually (P=.01), director having a PhD vs MD degree (P=.002), director board certification (P=.03), independent (P <.001) and hospital (P=.01) laboratories vs research laboratory, participation in proficiency testing (P<.001), and Clinical Laboratory Improvement Amendment certification (P=.006). Seventy percent of laboratories provided access to genetic counseling, 69% had a confidentiality policy, and 45% required informed consent prior to testing.
Conclusion The finding that a number of laboratories had QA scores that may reflect suboptimal laboratory practices suggests that both personnel qualification and laboratory practice standards are most in need of improvement to ensure quality in clinical molecular genetic testing laboratories.
Author Affiliations: Departments of Human Genetics (Drs McGovern and Desnick and Ms Benach), Pediatrics (Drs McGovern and Desnick), and Biomathematics (Dr Wallenstein), Mount Sinai School of Medicine, New York, NY, and Division of Laboratory Systems, Public Health Practice Program Office, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Keenlyside).
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