J Gen Intern Med. 2010 January; 25(Suppl 1): 38–43.
© Society of General Internal Medicine 2009
Developing and Sustaining Quality Improvement Partnerships in the VA: The Colorectal Cancer Care Collaborative
1Health Services Research & Development (HSR&D) Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC USA
2Division of General Internal Medicine, Duke University Medical Center, Durham, NC USA
3HSR&D Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN USA
4Division of General Internal Medicine, University of Minnesota School of Medicine, Minneapolis, MN USA
5Office of Quality and Performance, Veterans Health Administration Central Office, Washington, DC USA
6Veterans Affairs New England Healthcare System, Bedford, MA USA
7Primary Care Service, Bedford Veterans Affairs Medical Center, Bedford, MA USA
8Section of General Internal Medicine, Boston University School of Medicine, Boston, MA USA
9Veterans Affairs Great Lakes Healthcare System, Hines, IL USA
10Division of General Internal Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, IL USA
11Office of Systems Redesign, Veterans Health Administration Central Office, Washington, DC USA
12HSR&D Center of Excellence on Implementing Evidence-Based Practice, Roudebush Veterans Affairs Medical Center, Indianapolis, IN USA
13Regenstrief Institute Inc., Indianapolis, IN USA
14Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN USA
15National Center for Patient Safety Field Office, White River Junction Veterans Affairs Medical Center, White River Junction, VT USA
16Department of Psychiatry, Dartmouth Medical School, Hanover, NH USA
17Office of Patient Care Services, Veterans Health Administration Central Office, Washington, DC USA
18Division of Medical Oncology, Duke University Medical Center, Durham, NC USA
19Division of General Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD USA
20Division of Gastroenterology, Duke University Medical Center, Durham, NC USA
Beginning in 2005, the research and operation/clinical arms of the Veterans Affairs (VA) health care system formed a partnership aimed at improving the quality of colorectal cancer (CRC) diagnosis and care. The Office of Quality and Performance, Quality Enhancement Research Initiative (QUERI), Systems Redesign Program, Office of Patient Care Services and Office of the Deputy Under-Secretary for Health for Operations and Management (DUSH-OM) noted the need to reduce the time from positive CRC screening to diagnosis and enhance the timeliness and use of guideline-concordant CRC care. As a result, they conducted the Colorectal Cancer Care Collaborative (C4). C4 started with a diagnosis quality improvement collaborative, which was followed by a CRC treatment improvement collaborative, and ongoing efforts to spread both diagnosis and treatment improvements throughout the VA. Lessons learned about the organization of quality improvement (QI) and measurement are providing a framework for ongoing efforts to improve cancer care in the VA.
The focus of QUERI is bringing together research and operations to address significant health care issues facing veterans. However, C4 represents one of the first times that the specific combination of primary partner organizations have worked together on such an expansive QI initiative. This effort embodies a melding of perspectives and skills with the common goal of enhancing care.
Cancer care specialties are relatively new to the types of quality measurement and improvement techniques that have been extensively utilized to improve chronic illness care in primary care settings. Although successful collaboratives focused on increasing the rate of cancer screening (e.g., among Federally Qualified Health Centers)1
have occurred, we are unaware of any previous large-scale efforts to conduct collaboratives aimed at the continuum of cancer diagnosis and treatment. Our objective is to discuss how C4 sought to answer questions key to the development of a comprehensive program to address the quality of care for specific chronic illnesses, including cancer.