Implementing Advanced Comprehensive Diabetes Care Within the Veterans Affairs Learning Health System.

BACKGROUND: Telehealth can improve glycemic control for patients with type 2 diabetes (T2D), but programs must be designed in a manner that facilitates real-world uptake and effectiveness within learning health systems (LHS). OBJECTIVE: To highlight how the Veterans Affairs (VA) LHS supports real-world practice change by examining Advanced Comprehensive Diabetes Care (ACDC), a telehealth program for persistently poor T2D control, in the context of the Learning Health System Consolidated Framework (LHS-CF) taxonomy. DESIGN: Evaluation of program implementation within an LHS. PARTICIPANTS: N = 1154 real-world ACDC participants INTERVENTIONS: ACDC is a 6-month program that leverages widely available VA telehealth infrastructure to deliver telemonitoring, self-management support, and medication management. MAIN MEASURES: In applying the LHS-CF, we accessed clinical hemoglobin A1c (HbA1c) data, examined ACDC encounter completion, and interviewed participants and staff. KEY RESULTS: ACDC's development benefited from LHS-CF Enabling Conditions, including a workforce prepared to engage in structured learning and quality improvement; well-developed clinical data systems; strong VA investments in innovation; and a collaborative culture. Consequently, ACDC has contributed to multiple LHS-CF-aligned Bodies of Work, including building new evidence to improve T2D outcomes; translation of effective, telehealth-based T2D care into practice; authentic engagement of partners; ongoing analyses of data to support effective care; and development of new approaches to foster innovation and improvement. In practice, ACDC has reduced HbA1c from 9.7% at baseline to 8.0% at 6 months (-1.7%, 95% CI -1.7, -1.6, p < 0.0001), with retention of this benefit at 4 years; the program has been delivered with good fidelity and has been valued by participants and staff. CONCLUSIONS: The conditions created by VA's LHS facilitate the development, testing, and implementation of programs like ACDC, which promote further LHS success. As a result of its intentional development within VA's LHS, ACDC is well-positioned to improve outcomes for Veterans with poorly controlled T2D nationwide.

Duke Scholars

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