Effectiveness of a virtual quality improvement training program to improve reach of weight management programs within a large health system

Abstract

AbstractObjectiveTo 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 SettingData sources included VHA electronic health record (EHR) data, surveys, and LEAP coaching field notes.Study DesignA 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 MethodsThirty 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 findingsFifty‐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.ConclusionControl 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.