Effect of implementation of a clinical checklist on the evaluation of constitutional mismatch repair deficiency in a neurofibromatosis clinic.
9 affiliations
- 1Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA.
- 2Indiana University Health Physicians, Indianapolis, IN, USA.
- 3Division of Pediatric Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.
- 4Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Indiana University School of Medicine, Indianapolis, IN, USA.
- 5Indiana University Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA.
- 6Department of Pediatrics, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA.
- 7Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA. [email protected].
- 8Indiana University Health Physicians, Indianapolis, IN, USA. [email protected].
- 9IU Health Simon Cancer Center, 1030 W. Michigan St, Ste 3307, Indianapolis, IN, 46202, USA. [email protected].
Abstract
Background
Children with constitutional mismatch repair deficiency (CMMRD) require early and intensive cancer surveillance. Due to phenotypic overlap between CMMRD and neurofibromatosis type 1 (NF1), some children with CMMRD receive an incorrect diagnosis of NF1 and are inappropriately managed for their cancer risk. This study evaluated the effectiveness of a clinical checklist in identifying individuals for whom CMMRD evaluation is recommended.Procedure
Providers in a neurofibromatosis clinic implemented published CMMRD evaluation checklists into their clinical notes. Phase 1 of the study consisted of retrospective chart review prior to incorporation of the checklist. Phase 2 consisted of prospective chart review after checklist implementation.Results
Phase 1 included 81 patients; Phase 2 included 60 patients. In Phase 2, ambiguous ("Unknown") checklist responses were reduced, and patients were more likely to meet criteria for CMMRD evaluation. Individuals in Phase 2 were more likely to be referred for genetic evaluation compared to Phase 1. There was no correlation between patients meeting criteria for CMMRD evaluation and being referred to genetics in either cohort.Conclusions
These results suggest a clinical CMMRD checklist is a useful tool for identifying individuals for whom CMMRD evaluation is recommended. Patients with a nondiagnostic NF1 workup who meet CMMRD evaluation criteria require further follow-up to aid in appropriate diagnosis and management.
Related
- Implementation of the Trigger Checklist and assertive outreach to reduce drug-related harm in the Emergency Department: A realist evaluation
- Tailoring neurofibromatosis type 1 care to Singapore: From consensus to implementation
- Implementation of a Structured Perioperative Checklist-Based Standardization Process and Early Postoperative Outcomes After Bariatric Surgery: A Single-Center Retrospective Pre–Post Cohort Study
- What are the implementation lessons from a high-volume cataract screening and surgical programme? A mixed-methods implementation evaluation in Sierra Leone
- Design, implementation, and evaluation of a comprehensive educational program for microbiology laboratory personnel and graduate students in teaching hospitals
BibTeX
@article{mcdonald2026effect,
title = {{Effect of implementation of a clinical checklist on the evaluation of constitutional mismatch repair deficiency in a neurofibromatosis clinic.}},
author = {Bridget McDonald and Jennifer Ivanovich and Leah Wetherill and Laurence Walsh and Jayne Vonbergen and Lisa Langsford and Steven D Rhodes and Leigh Anne Stout},
journal = {Journal of community genetics},
year = {2026},
month = oct,
doi = {10.1007/s12687-026-00967-8},
url = {https://europepmc.org/article/MED/42957923},
note = {CC BY},
}
RIS
TY - JOUR
TI - Effect of implementation of a clinical checklist on the evaluation of constitutional mismatch repair deficiency in a neurofibromatosis clinic.
AU - Bridget McDonald
AU - Jennifer Ivanovich
AU - Leah Wetherill
AU - Laurence Walsh
AU - Jayne Vonbergen
AU - Lisa Langsford
AU - Steven D Rhodes
AU - Leigh Anne Stout
PY - 2026
DA - 2026/10/30
JO - Journal of community genetics
DO - 10.1007/s12687-026-00967-8
UR - https://europepmc.org/article/MED/42957923
AB - Background Children with constitutional mismatch repair deficiency (CMMRD) require early and intensive cancer surveillance. Due to phenotypic overlap between CMMRD and neurofibromatosis type 1 (NF1), some children with CMMRD receive an incorrect diagnosis of NF1 and are inappropriately managed for their cancer risk. This study evaluated the effectiveness of a clinical checklist in identifying individuals for whom CMMRD evaluation is recommended.Procedure Providers in a neurofibromatosis clinic implemented published CMMRD evaluation checklists into their clinical notes. Phase 1 of the study consisted of retrospective chart review prior to incorporation of the checklist. Phase 2 consisted of prospective chart review after checklist implementation.Results Phase 1 included 81 patients; Phase 2 included 60 patients. In Phase 2, ambiguous ("Unknown") checklist responses were reduced, and patients were more likely to meet criteria for CMMRD evaluation. Individuals in Phase 2 were more likely to be referred for genetic evaluation compared to Phase 1. There was no correlation between patients meeting criteria for CMMRD evaluation and being referred to genetics in either cohort.Conclusions These results suggest a clinical CMMRD checklist is a useful tool for identifying individuals for whom CMMRD evaluation is recommended. Patients with a nondiagnostic NF1 workup who meet CMMRD evaluation criteria require further follow-up to aid in appropriate diagnosis and management.
SN - 1868-310X
SN - 1868-6001
ER -