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

Matthew J Crowley1,2, Sarah L Cutrona3,4, Amy S Jeffreys5

  • 1Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC, USA. matthew.crowley@va.gov.

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|November 4, 2025
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Summary
This summary is machine-generated.

The Veterans Affairs (VA) Learning Health System (LHS) successfully implemented the Advanced Comprehensive Diabetes Care (ACDC) telehealth program, significantly improving glycemic control in type 2 diabetes (T2D) patients. This program demonstrates how LHS frameworks enhance real-world healthcare practice changes.

Keywords:
VA healthcare systemclinical trial design and implementationprogram evaluationquality improvementrural health

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Area of Science:

  • Healthcare Management
  • Digital Health
  • Diabetes Care

Background:

  • Telehealth interventions can enhance glycemic control for patients with type 2 diabetes (T2D).
  • Effective telehealth programs require design considerations for real-world uptake and impact within Learning Health Systems (LHS).

Purpose of the Study:

  • To examine how the Veterans Affairs (VA) LHS facilitates practice change using the Advanced Comprehensive Diabetes Care (ACDC) telehealth program.
  • To analyze the ACDC program's implementation for type 2 diabetes (T2D) management within the Learning Health System Consolidated Framework (LHS-CF) taxonomy.

Main Methods:

  • An evaluation of the ACDC program's implementation within an LHS setting.
  • Analysis of clinical hemoglobin A1c (HbA1c) data, ACDC encounter completion rates, and participant/staff interviews for 1154 participants.
  • The ACDC program is a 6-month intervention utilizing VA telehealth infrastructure for telemonitoring, self-management support, and medication management.

Main Results:

  • ACDC's development leveraged LHS-CF Enabling Conditions, including workforce preparedness, robust data systems, VA innovation investment, and a collaborative culture.
  • The program demonstrated significant HbA1c reduction from 9.7% to 8.0% at 6 months (p < 0.0001), with sustained benefits at 4 years.
  • ACDC was implemented with good fidelity, positively valued by participants and staff, and contributed to evidence building, care translation, and innovation.

Conclusions:

  • The VA's LHS provides conditions conducive to developing, testing, and implementing telehealth programs like ACDC.
  • The ACDC program, intentionally developed within the VA LHS, is poised to improve outcomes for Veterans with poorly controlled T2D nationwide.