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Implementation of collaborative depression management at community-based primary care clinics: an evaluation
Amy M Bauer1, Vanessa Azzone, Howard H Goldman
1Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St, Box 356560, Seattle, WA 98195, USA. abauer1@u.washington.edu
Psychiatric Services (Washington, D.C.)
|September 3, 2011
Summary
Clinic site significantly impacts depression care quality and patient outcomes in collaborative care models. Despite standardized training, variations in implementation led to differing results in early follow-up, pharmacotherapy, and symptom improvement.
Area of Science:
- Healthcare delivery research
- Mental health services research
- Quality improvement science
Background:
- Collaborative care models aim to improve depression management in primary care settings.
- Variability in implementation can affect the quality and effectiveness of healthcare interventions.
- Understanding site-specific factors is crucial for optimizing collaborative care for depression.
Purpose of the Study:
- To evaluate a large collaborative care demonstration project for depression in community health centers.
- To examine the influence of clinic site on quality of care indicators and patient symptom improvement.
- To identify factors contributing to variability in collaborative care implementation and outcomes.
Main Methods:
- A quasi-experimental study analyzed data from 2,821 adult patients with depression symptoms treated between 2006 and 2009.
- Six community health organizations implemented a collaborative care model featuring a web-based registry, care management, and psychiatric consultation.
- Multivariate logistic regression and Cox proportional hazards models were used to assess quality measures and symptom improvement, adjusting for patient characteristics.
Main Results:
- A significant portion of patients experienced meaningful depression improvement, often rapidly.
- Substantial differences were observed across clinic sites in the likelihood of receiving early follow-up and appropriate pharmacotherapy.
- Patient outcomes, including symptom improvement rates and time to improvement, varied significantly between sites, independent of patient characteristics.
Conclusions:
- Organizations demonstrated considerable variability in adopting system changes for clinical care, despite uniform training and resources.
- Higher performance on quality indicators was associated with better patient outcomes.
- Clinic site is a significant determinant of success in implementing and benefiting from collaborative care for depression.
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