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Developing and Sustaining Quality Improvement Partnerships in the VA: The Colorectal Cancer Care Collaborative

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Abstract

Objective

The Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) seeks to develop partnerships between VA health services researchers and clinical managers, with the goal of designing and evaluating interventions to improve the quality of VA health care.

Methods

In the present report we describe one such initiative aimed at enhancing the continuum of colorectal cancer (CRC) care, including diagnosis, treatment and surveillance–the Colorectal Cancer Care Collaborative (C4).

Results

We describe the process and thinking that led to two parallel quality improvement “collaboratives” that addressed (1) CRC screening and diagnostic follow-up and (2) the guideline concordance and timeliness of CRC treatment. Additionally, we discuss ongoing effort to spread lessons learned during the first stages of the project, which initially occurred at only a subset of VA facilities, throughout the VA health care system. The description of this initiative is organized around key questions that must be answered when developing, sustaining and spreading multi-component quality improvement interventions.

Conclusion

We conclude with a discussion of lessons learned that we believe would apply to similar initiatives elsewhere, even if they address different clinical issues in health care settings with different organizational structures.

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Acknowledgements

The Colorectal Cancer Care Collaborative involved teams of dedicated VA employees from 21 facilities participating in the diagnosis improvement collaborative and 28 facilities participating in the treatment improvement collaborative. We thank all of them for their hard work and dedication to improving the care provided to veterans. Work of the C4 collaborative was summarized at the Veterans Affairs Quality Enhancement Research Initiative National Meeting on December 11, 2008, in Phoenix, AZ.

Funding

Funding for quality improvement activities of the Colorectal Cancer Care Collaborative (C4) was provided by the VA Office of Quality and Performance and the Office of Systems Redesign. Development of the Cancer Care Quality Measurement System (CCQMS) was funded by the VA Health Services Research and Development Service (HSR&D grant CRT-05-338). Initial funding leading to the development of the CCQMS was provided by the National Cancer Institute (NCI) (V246S-00054, Y1-PC-8218-01, and HHSN261200800504P). Additional funding for C4 measurement activities was funded through core funding of the HSR&D Colorectal Cancer Care Quality Enhancement Research Initiative (QUERI). Dr. Jackson is a VA HSR&D Merit Review Entry Program awardee (MRP 05-312). During part of this work, Dr. Powell was the implementation coordinator for the Colorectal Cancer QUERI. Dr. Haggstrom has a VA HSR&D career development award (CD207016-2). Dr. Povenzale is funded in part by a K-24 career development award from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (5 K24 DK002926).

Disclaimer

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs of the United States government.

Conflict of Interest

The authors have no conflicts of interest to report. All authors, with the exception of Ms. Parlier (retired), are current employees of the Department of Veterans Affairs. The authors received no compensation apart from their employment.

Author information

Authors and Affiliations

  1. Health Services Research & Development (HSR&D) Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA

    George L. Jackson PhD, MHA, Leah L. Zullig MPH & Dawn Provenzale MD, MS

  2. Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA

    George L. Jackson PhD, MHA

  3. HSR&D Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, USA

    Adam A. Powell PhD, MBA & Nancy Koets PsyD

  4. Division of General Internal Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA

    Adam A. Powell PhD, MBA

  5. Office of Quality and Performance, Veterans Health Administration Central Office, Washington, DC, USA

    Diana L. Ordin MD, MPH & Joseph Francis MD, MPH

  6. Veterans Affairs New England Healthcare System, Bedford, MA, USA

    James E. Schlosser MD, MBA, Janis Hersh MBA & George Ponte RRT

  7. Primary Care Service, Bedford Veterans Affairs Medical Center, Bedford, MA, USA

    James E. Schlosser MD, MBA

  8. Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA

    James E. Schlosser MD, MBA

  9. Veterans Affairs Great Lakes Healthcare System, Hines, IL, USA

    Jeffery Murawsky MD

  10. Division of General Internal Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA

    Jeffery Murawsky MD

  11. Office of Systems Redesign, Veterans Health Administration Central Office, Washington, DC, USA

    Fabiane Erb BA, Renee Parlier RN, MSN & Michael L. Davies MD

  12. HSR&D Center of Excellence on Implementing Evidence-Based Practice, Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA

    David A. Haggstrom MD, MAS

  13. Regenstrief Institute Inc., Indianapolis, IN, USA

    David A. Haggstrom MD, MAS

  14. Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA

    David A. Haggstrom MD, MAS

  15. National Center for Patient Safety Field Office, White River Junction Veterans Affairs Medical Center, White River Junction, VT, USA

    Peter D. Mills PhD, MS

  16. Department of Psychiatry, Dartmouth Medical School, Hanover, NH, USA

    Peter D. Mills PhD, MS

  17. Office of Patient Care Services, Veterans Health Administration Central Office, Washington, DC, USA

    Michael J. Kelley MD

  18. Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA

    Michael J. Kelley MD

  19. Division of General Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA

    Michael L. Davies MD

  20. Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA

    Dawn Provenzale MD, MS

Authors
  1. George L. Jackson PhD, MHA
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  2. Adam A. Powell PhD, MBA
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  3. Diana L. Ordin MD, MPH
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  8. Leah L. Zullig MPH
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  9. Fabiane Erb BA
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  10. Renee Parlier RN, MSN
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  11. David A. Haggstrom MD, MAS
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  12. Nancy Koets PsyD
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  13. Peter D. Mills PhD, MS
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  14. Joseph Francis MD, MPH
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  15. Michael J. Kelley MD
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  16. Michael L. Davies MD
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  17. Dawn Provenzale MD, MS
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Consortia

for the VA Colorectal Cancer Care Planning Committee Members

Corresponding author

Correspondence to George L. Jackson PhD, MHA.

Additional information

The following individuals have also served on the Colorectal Cancer Care Collaborative Planning Committee: Jacki Bebb, BSB/M; Hanna E. Bloomfield, MD, MPH; Cody Couch; Carrie J. DeKorte, PharmD, BCPS, FACHE; Deborah Duncan, MPH, CHES; Jill Edwards, NP; Theresa Hellings, RD; John M. Inadomi, MD; Laura Kochevar, Ph.D.; Odette Levesque, RN, MBA, FACHE ; Irma McCaffrey, BA; Heidi L. Martin, BSN, MPH; RimaAnn O. Nelson, RN, MPH/HAS

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Jackson, G.L., Powell, A.A., Ordin, D.L. et al. Developing and Sustaining Quality Improvement Partnerships in the VA: The Colorectal Cancer Care Collaborative. J GEN INTERN MED 25 (Suppl 1), 38–43 (2010). https://doi.org/10.1007/s11606-009-1155-x

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