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January 17, 2017

A Framework for Disseminating Clinical Best Practices in the VA Health System

Author Affiliations
  • 1US Department of Veterans Affairs, Washington, DC
JAMA. 2017;317(3):255-256. doi:10.1001/jama.2016.18764

Widespread adoption of clinical best practices has been challenging for health systems domestically and abroad. In 2001, an Institute of Medicine report noted that new, evidence-based clinical practices (such as computed tomography screening for lung cancer) can take an average of 17 years to reach patients consistently throughout the health system.1 Recent reports indicate no improvement in this time lag after 2010.2 As health systems evolve, rapid change remains a challenge. The “learning health system” is a proposed framework to achieve this goal; however, attempts to put this framework into practice have fallen short.3,4 The Department of Veterans Affairs Diffusion of Excellence (VADOE) is a learning health system approach that aligns best practices with system assets (eg, governance structures and common communications platforms) to achieve rapid dissemination of these improvement projects and draws from thoughtful guidelines for dissemination and improvement in health care.4