Integrating practices' change processes into improving quality of depression care

Area of Science:

• Healthcare quality improvement
• Primary care research
• Depression management

Background:

• Primary care practices need better strategies for implementing and sustaining system changes.
• An improvement collaborative project aimed to enhance depression care quality and change processes.
• A qualitative study explored how practices adopted effective change processes following the project.

Purpose of the Study:

• To examine primary care practices' adoption of effective change processes.
• To identify features associated with successful adoption of change processes for improved depression care.

Main Methods:

• Qualitative data collected from 16 primary care practices.
• Multistep qualitative analysis to identify exemplar practices.
• Constant comparative method to identify influential features for change process adoption.

Main Results:

• Practices showed varied improvements in depression care and adoption of change processes.
• Practices with the greatest depression care improvements also adopted more effective change processes.
• Specific features were associated with exemplar practices that improved both care and change processes.

Conclusions:

• Effective quality improvement must address both clinical content and change processes.
• Improvement collaborative projects can impact chronic disease management, including depression.
• Findings contribute to understanding the mixed effects of collaborative projects in healthcare.