title: Developing and sustaining quality improvement partnerships in the VA: the Colorectal Cancer Care Collaborative.
abstract: OBJECTIVE
  The Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) seeks to develop partnerships between VA health services researchers and clinical managers, with the goal of designing and evaluating interventions to improve the quality of VA health care.
  
  
  METHODS
  In the present report we describe one such initiative aimed at enhancing the continuum of colorectal cancer (CRC) care, including diagnosis, treatment and surveillance-the Colorectal Cancer Care Collaborative (C4).
  
  
  RESULTS
  We describe the process and thinking that led to two parallel quality improvement "collaboratives" that addressed (1) CRC screening and diagnostic follow-up and (2) the guideline concordance and timeliness of CRC treatment. Additionally, we discuss ongoing effort to spread lessons learned during the first stages of the project, which initially occurred at only a subset of VA facilities, throughout the VA health care system. The description of this initiative is organized around key questions that must be answered when developing, sustaining and spreading multi-component quality improvement interventions.
  
  
  CONCLUSIONS
  We conclude with a discussion of lessons learned that we believe would apply to similar initiatives elsewhere, even if they address different clinical issues in health care settings with different organizational structures.
authors.affiliation: Health Services Research & Development Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA. george.l.jackson@duke.edu
authors.forename: George L
authors.initials: GL
authors.lastname: Jackson
authors.forename: Adam A
authors.initials: AA
authors.lastname: Powell
authors.forename: Diana L
authors.initials: DL
authors.lastname: Ordin
authors.forename: James E
authors.initials: JE
authors.lastname: Schlosser
authors.forename: Jeffery
authors.initials: J
authors.lastname: Murawsky
authors.forename: Janis
authors.initials: J
authors.lastname: Hersh
authors.forename: George
authors.initials: G
authors.lastname: Ponte
authors.forename: Leah L
authors.initials: LL
authors.lastname: Zullig
authors.forename: Fabiane
authors.initials: F
authors.lastname: Erb
authors.forename: Renee
authors.initials: R
authors.lastname: Parlier
authors.forename: David A
authors.initials: DA
authors.lastname: Haggstrom
authors.forename: Nancy
authors.initials: N
authors.lastname: Koets
authors.forename: Peter D
authors.initials: PD
authors.lastname: Mills
authors.forename: Joseph
authors.initials: J
authors.lastname: Francis
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kelley
authors.forename: Michael L
authors.initials: ML
authors.lastname: Davies
authors.forename: Dawn
authors.initials: D
authors.lastname: Provenzale
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000628:therapy; D003299:Cooperative Behavior; D006801:Humans; D016730:Program Development / Q000379:methods / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards*; D014728:Veterans