Browsing by Author "Przygodzki, Ronald"

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    Identifying End Users' Preferences about Structuring Pharmacogenetic Test Orders in an Electronic Health Record System
    (Elsevier, 2020-10) Hull, Leland E.; Vassy, Jason L.; Stone, Annjanette; Chanfreau-Coffinier, Catherine C.; Heise, Craig W.; Pratt, Victoria M.; Przygodzki, Ronald; Voils, Corrine I.; Voora, Deepak; Wang-Rodriguez, Jessica; Schichman, Steven A.; Scheuner, Maren T.; Medical and Molecular Genetics, School of Medicine
    Pharmacogenetics (PGx) testing can be used for detecting genetic variations that may affect an individual's anticipated metabolism of, or response to, medications. Although several studies have focused on developing tools for delivering results from PGx testing, there is a relative dearth of information about how to design provider-friendly electronic order-entry systems for PGx. The U.S. Department of Veterans Affairs (VA) is preparing to implement a new electronic health records system. In this study, VA PGx test end users were surveyed about their preferences for how electronic test orders for PGx should be structured, including the nomenclature that should be used to search for and identify PGx-test orders, whether to offer single- versus multigene tests, and whether information about test methodology should be included in the order name. Responses were analyzed systematically to identify areas of agreement and disagreement with the survey options, and areas where respondents' opinions diverged. End users endorsed preferences for flexible ways to identify and order PGx tests and multigene panel tests; opinions on whether test methodology should be included in the test name were divergent. The results could be used for both informing the VA's new electronic health records implementation (including how PGx tests are searched for and ordered) and for providing insights for other health systems implementing PGx-testing programs.
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    Penetrance and Pleiotropy of Polygenic Risk Scores for Schizophrenia, Bipolar Disorder, and Depression Among Adults in the US Veterans Affairs Health Care System
    (American Medical Association, 2022-09-14) Bigdeli, Tim B.; Voloudakis, Georgios; Barr, Peter B.; Gorman, Bryan R.; Genovese, Giulio; Peterson, Roseann E.; Burstein, David E.; Velicu, Vlad I.; Li, Yuli; Gupta, Rishab; Mattheisen, Manuel; Tomasi, Simone; Rajeevan, Nallakkandi; Sayward, Frederick; Radhakrishnan, Krishnan; Natarajan, Sundar; Malhotra, Anil K.; Shi, Yunling; Zhao, Hongyu; Kosten, Thomas R.; Concato, John; O'Leary, Timothy J.; Przygodzki, Ronald; Gleason, Theresa; Pyarajan, Saiju; Brophy, Mary; Huang, Grant D.; Muralidhar, Sumitra; Gaziano, J. Michael; Aslan, Mihaela; Fanous, Ayman H.; Harvey, Philip D.; Roussos, Panos; Cooperative Studies Program (CSP); Million Veteran Program (MVP); Psychiatry, School of Medicine
    Importance: Serious mental illnesses, including schizophrenia, bipolar disorder, and depression, are heritable, highly multifactorial disorders and major causes of disability worldwide. Objective: To benchmark the penetrance of current neuropsychiatric polygenic risk scores (PRSs) in the Veterans Health Administration health care system and to explore associations between PRS and broad categories of human disease via phenome-wide association studies. Design, setting, and participants: Extensive Veterans Health Administration's electronic health records were assessed from October 1999 to January 2021, and an embedded cohort of 9378 individuals with confirmed diagnoses of schizophrenia or bipolar 1 disorder were found. The performance of schizophrenia, bipolar disorder, and major depression PRSs were compared in participants of African or European ancestry in the Million Veteran Program (approximately 400 000 individuals), and associations between PRSs and 1650 disease categories based on ICD-9/10 billing codes were explored. Last, genomic structural equation modeling was applied to derive novel PRSs indexing common and disorder-specific genetic factors. Analysis took place from January 2021 to January 2022. Main outcomes and measures: Diagnoses based on in-person structured clinical interviews were compared with ICD-9/10 billing codes. PRSs were constructed using summary statistics from genome-wide association studies of schizophrenia, bipolar disorder, and major depression. Results: Of 707 299 enrolled study participants, 459 667 were genotyped at the time of writing; 84 806 were of broadly African ancestry (mean [SD] age, 58 [12.1] years) and 314 909 were of broadly European ancestry (mean [SD] age, 66.4 [13.5] years). Among 9378 individuals with confirmed diagnoses of schizophrenia or bipolar 1 disorder, 8962 (95.6%) were correctly identified using ICD-9/10 codes (2 or more). Among those of European ancestry, PRSs were robustly associated with having received a diagnosis of schizophrenia (odds ratio [OR], 1.81 [95% CI, 1.76-1.87]; P < 10-257) or bipolar disorder (OR, 1.42 [95% CI, 1.39-1.44]; P < 10-295). Corresponding effect sizes in participants of African ancestry were considerably smaller for schizophrenia (OR, 1.35 [95% CI, 1.29-1.42]; P < 10-38) and bipolar disorder (OR, 1.16 [95% CI, 1.11-1.12]; P < 10-10). Neuropsychiatric PRSs were associated with increased risk for a range of psychiatric and physical health problems. Conclusions and relevance: Using diagnoses confirmed by in-person structured clinical interviews and current neuropsychiatric PRSs, the validity of an electronic health records-based phenotyping approach in US veterans was demonstrated, highlighting the potential of PRSs for disentangling biological and mediated pleiotropy.