Establishing the Clinical Utility of First StepDx PLUS and NextStepDx PLUS Study
Establishing the Clinical Utility of First StepDx PLUS and NextStepDx PLUS Study
The study uses a randomized controlled study design of pediatric neurologists and
 developmental pediatricians and front-line (primary care) pediatricians to determine if use
 of FirstStepDx PLUS and Next StepDx PLUS are associated with higher clinical quality, less
 variability in clinical practice, and lower costs from decreased resource utilization. The
 Clinical Performance and Value Vignettes (CPV) used in this study simulate a clinical
 encounter for individuals with an atypical phenotype and clinical presentation indicative of
 a possible genetic disorder. We will measure the difference in combined diagnostic and
 treatment CPV® domain score post-intervention versus baseline comparing intervention and
 control groups
The study is an interventional longitudinal study design of physician practice. 225
 specialist and general pediatricians without previous exposure to FirstStepDx PLUS or
 NextStepDx PLUS will be selected from a nationally representative list of approximately
 25,000 board-certified pediatricians and 5,000 specialists. These physicians will be
 randomized into one of three arms: to receive information regarding FirstStepDx PLUS
 ("Intervention A"), to receive information about FirstStepDx PLUS and NextStepDx PLUS
 ("Intervention B") for use in clinical practice, and controls not receiving any intervention.
 Specifically we will test the hypotheses:

 1. Clinical practice, specifically decisions around treatment of individuals with disorders
 postnatal development including DD, ASD, and ID will vary widely among all physician
 types. This documentation of variation in practice will demonstrate the need for a new
 diagnostic service that FirstStepDx PLUS and NextStepDx PLUS would fulfill

 2. FirstStepDx PLUS and NextStepDx PLUS will improve the quality and appropriateness of
 care and therapeutic plans, as measured by the number of physicians that correctly act
 on the results of the assay

 A Physician Questionnaire will be administered to all physicians. This questionnaire will
 assess physician, patient and practice characteristics. Data gathered from this set of
 questions will become part of the baseline (pre-intervention) assessment and used for
 analysis. At the baseline assessment, Clinical Performance and Value (CPVs) Vignettes, a
 validated tool to measure physician performance and behavior will be used. CPV vignettes have
 been used to establish clinical utility in the molecular diagnostic space.

 The CPV vignettes used in this study will simulate a clinical encounter for a patient with an
 atypical clinical presentation indicative of a possible genetic developmental disorder. Each
 physician will provide open-ended responses regarding clinical care. These responses are
 scored in five domains (taking a medical history, performing a physical examination, ordering
 appropriate tests, making a diagnosis and prescribing treatment against explicit evidence and
 criteria as determined by the literature and by expert physicians. Results are presented as
 percentage correct controlling for primacy effects using case within pair randomization. Each
 case will take approximately 15-20 minutes to complete. All case responses will be completed
 electronically online and confidential. No physician or practice names are used when
 reporting the results of the study.

 The CPVs will be randomly assigned to physicians for each to complete 3 CPVs™ (one from each
 type). Each of the CPVs will be scored by physicians for changes in clinical practice
 including treatment changes, frequency of follow up, laboratory tests and imaging studies
 ordered - see for scoring sheet.

 The objective of this study is to assess how FirstStepDx PLUS (and NextStepDx PLUS) testing
 affects the variability of clinical practice and resultant impact.

 Primary Endpoint Differences in CPV diagnosis/treatment domain score post-intervention versus
 baseline for the intervention and control group physicians).

 Secondary Endpoints

 -  Difference in utilization of appropriate treatment including indicated versus
 unnecessary therapy pre- and post-intervention between intervention and control groups

 -  Difference in utilization of laboratory testing such as fluorescence in situ
 hybridization (FISH) analyses, global assessment, and utilization of other laboratory
 tests pre- and post-intervention, between intervention and control groups

 -  Difference in overall Clinical Performance and Value Vignettes (CPV®) scores
 post-intervention versus baseline between intervention and control groups
Inclusion Criteria:

 1. Provide consent to participate in the study

 2. Currently practicing board-certified physician in the following specialty areas:

 1. Pediatric neurologists

 2. Developmental pediatricians

 3. General pediatricians

 3. Have practiced as a board-certified physician for greater than 2 but less than 30
 years.

 4. English-speaking

 5. Community / non-academic based practice setting

 6. ≥30 pediatric patients under care annually

 7. Access to the internet

 Exclusion Criteria:

 1. Not board certified in their respective area of care

 2. Academic-based practice

 3. Have previously used FirstStepDx PLUS and/or NextStepDx PLUS in their care delivery

 4. Have practiced as a board-certified physician for less than 2 or greater than 30
 years.

 5. Follow <30 pediatric patients annually

 6. Non-English speaking

 7. Unable to access the internet