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

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).

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.

Evaluation of program implementation within an LHS.

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.

In applying the LHS-CF, we accessed clinical hemoglobin A1c (HbA1c) data, examined ACDC encounter completion, and interviewed participants and staff.

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.

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.