{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:52:53Z","timestamp":1792788773641,"version":"4.5.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","funder":[{"name":"Melbourne Genomics"},{"name":"State Government of Victoria","id":[{"id":"https:\/\/ror.org\/02xvc5r05","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Royal Australian College of Physicians","award":["Jacquot Research Establishment fellowship"],"award-info":[{"award-number":["Jacquot Research Establishment fellowship"]}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"abstract":"\n Key Points<\/jats:title>\n \n \n \n We evaluated a hub and spoke mainstreaming model to enable nephrologists to order genomic tests independently in their clinic across the state of Victoria.<\/jats:p>\n <\/jats:list-item>\n \n Over 1000 tests were ordered, with the diagnostic yield remaining similar regardless of ordered by local nephrologists or tertiary genomics services.<\/jats:p>\n <\/jats:list-item>\n \n A mainstreaming model proved feasible, scalable, and clinically effective, offering a practical framework for integrating genomics to routine kidney care.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Genomic testing has substantial diagnostic and clinical value in nephrology, yet integrating testing into routine care requires service-level changes to ensure timely and equitable access.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted an observational cohort study at four tertiary centers, with a pragmatic, quasi-experimental design to evaluate evidence-informed, service-level interventions to make genomic testing more accessible and routinely embedded within nephrology practice. We implemented a hub and spoke model which provided nephrologists with training, practical resources, and regular case-based discussions, to support test ordering and interpretation within their own clinics. Laboratory audits (June 2021\u2013July 2024) evaluated how public reimbursement and implementation interventions influenced testing patterns. Three periods were compared: prefunding, postfunding, and postintervention.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Across the study period, 1028 genomic tests were ordered (63% adults, 37% children; median age 32 years). Results were available for 1014 tests, with an overall diagnostic yield of 34%, which remained stable across all time points. The diagnostic yield was similar regardless of whether testing occurred at tertiary genomics services (249 of 772, 32%) or\n via<\/jats:italic>\n local nephrologists (92 of 242, 38%). The number of unique providers ordering tests was higher (T1: 37, T2: 69, T3: 87). The proportion of testing in mainstream nephrology settings rose from 23% to 74%, while absolute testing numbers in multidisciplinary clinics remained consistent over the study period.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Mainstreaming genomic testing in nephrology was feasible, scalable, and clinically effective. This model was associated with better access without compromising diagnostic yield and provides a practical framework for integrating genomic medicine into routine kidney care.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.0000001184","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T16:02:09Z","timestamp":1786982529000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Scaling up Genomics"],"prefix":"10.2215","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9268-8505","authenticated-orcid":false,"given":"Kushani","family":"Jayasinghe","sequence":"first","affiliation":[{"name":"Department of Nephrology, Medical Centre, Melbourne, Victoria, Australia"},{"name":"School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia"},{"name":"Department of Genomic Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5595-1753","authenticated-orcid":false,"given":"Rigan","family":"Tytherleigh","sequence":"additional","affiliation":[{"name":"Murdoch Children's Research Institute, Melbourne, Victoria, Australia"},{"name":"Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia"},{"name":"Melbourne Genomics Health Alliance, Walter and Eliza Hall Institute, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1107-8976","authenticated-orcid":false,"given":"Stephanie","family":"Best","sequence":"additional","affiliation":[{"name":"Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2128-8894","authenticated-orcid":false,"given":"Simon","family":"Bodek","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Melbourne, Parkville, Victoria, Australia"},{"name":"Clinical Genetics Service, Austin Health, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Bussa","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Medical Centre, Melbourne, Victoria, Australia"},{"name":"School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5966-4096","authenticated-orcid":false,"given":"Grainne","family":"Butler","sequence":"additional","affiliation":[{"name":"Murdoch Children's Research Institute, Melbourne, Victoria, Australia"},{"name":"Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3945-5817","authenticated-orcid":false,"given":"Ainsley","family":"Campbell","sequence":"additional","affiliation":[{"name":"Clinical Genetics Service, Austin Health, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4230-9140","authenticated-orcid":false,"given":"Amy","family":"Clarke","sequence":"additional","affiliation":[{"name":"Murdoch Children's Research Institute, Melbourne, Victoria, Australia"},{"name":"Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5998-6760","authenticated-orcid":false,"given":"Brendan","family":"Cusack","sequence":"additional","affiliation":[{"name":"Murdoch Children's Research Institute, Melbourne, Victoria, Australia"},{"name":"Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3610-8782","authenticated-orcid":false,"given":"Elizabeth","family":"Donaldson","sequence":"additional","affiliation":[{"name":"Department of Genomic Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoni","family":"Elbaum","sequence":"additional","affiliation":[{"name":"Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0160-4159","authenticated-orcid":false,"given":"Clara","family":"Gaff","sequence":"additional","affiliation":[{"name":"Murdoch Children's Research Institute, Melbourne, Victoria, 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