Search

Objective: To test effectiveness of the LEAP (Learn Engage Act Process) Program on engaging frontline Veteran Health Administration (VHA) medical center teams in continuous quality improvement (QI), a core capability for learning health systems. Data Sources and Study Setting: Data sources included VHA electronic health record (EHR) data, surveys, and LEAP coaching field notes. Study Design: A staggered difference‐in‐differences study was conducted. Fifty‐five facilities participated in LEAP across eight randomly assigned clusters of 6–8 facilities per cluster over 2 years. Non‐participating facilities were used as controls. A MOVE! weight management program team completed a Plan‐Do‐Study‐Act cycle of change supported by learning curriculum, coaching, and virtual collaboratives in LEAP facilities. Primary outcome was program reach to Veterans. A mixed‐effects model compared pre‐ versus post‐LEAP periods for LEAP versus control facilities. LEAP adherence, satisfaction, and cost to deliver LEAP were evaluated. Data Collection/Extraction Methods: Thirty months of facility‐level EHR MOVE! enrollment data were included in analyses. LEAP Satisfaction and QI skills were elicited via surveys at baseline and 6‐month post‐LEAP. Principal findings: Fifty‐five facilities were randomly assigned to eight time‐period‐based clusters to receive LEAP (71% completed LEAP) and 82 non‐participating facilities were randomly assigned as controls. Reach in LEAP and control facilities was comparable in the 12‐month pre‐LEAP period (p = 0.07). Though LEAP facilities experienced slower decline in reach in the 12‐month post‐LEAP period compared with controls (p < 0.001), this is likely due to unexplained fluctuations in controls. For LEAP facilities, satisfaction was high (all mean ratings >4 on a 5‐point scale), self‐reported use of QI methods increased significantly (p‐values <0.05) 6 months post‐LEAP, and delivery cost was $4024 per facility‐based team. Conclusion: Control facilities experienced declining reach in the 12‐month post‐LEAP period, but LEAP facilities did not, plus they reported higher engagement in QI, an essential capability for learning health systems. [ABSTRACT FROM AUTHOR]