TY - JOUR
AU - A. M. Bauer
AU - V. Azzone
AU - H. H. Goldman
AU - L. Alexander
AU - J. Unutzer
AU - B. Coleman-Beattie
AU - R. G. Frank
A1 - 
AB - Objective: This study evaluated a large demonstration project of collaborative care of depression at community health centers by examining the role of clinic site on two measures of quality care (early follow-up and appropriate pharmacotherapy) and on improvement of symptoms (score on Patient Health Questionnaire-9 reduced by 50% or </=5). Methods: A quasi-experimental study examined data on the treatment of 2,821 patients aged 18 and older with depression symptoms between 2006 and 2009 at six community health organizations selected in a competitive process to implement a model of collaborative care. The model's key elements were use of a Web-based disease registry to track patients, care management to support primary care providers and offer proactive follow-up of patients, and organized psychiatric consultation. Results: Across all sites, a plurality of patients achieved meaningful improvement in depression, and in many sites, improvement occurred rapidly. After adjustment for patient characteristics, multivariate logistic regression models revealed significant differences across clinics in the probability of receiving early follow-up (range .34-.88) or appropriate pharmacotherapy (range .27-.69) and in experiencing improvement (.36 to .84). Similarly, after adjustment for patient characteristics, Cox proportional hazards models revealed that time elapsed between first evaluation and the occurrence of improvement differed significantly across clinics (p<.001). Conclusions: Despite receiving similar training and resources, organizations exhibited substantial variability in enacting change in clinical care systems, as evidenced by both quality indicators and outcomes. Sites that performed better on quality indicators had better outcomes, and the differences were not attributable to patients' characteristics. (Psychiatric Services 62:1047-1053, 2011).
BT - Psychiatric services (Washington, D.C.)
C5 - Key & Foundational
CP - 9
CY - United States
DO - 10.1176/appi.ps.62.9.1047
IS - 9
JF - Psychiatric services (Washington, D.C.)
N2 - Objective: This study evaluated a large demonstration project of collaborative care of depression at community health centers by examining the role of clinic site on two measures of quality care (early follow-up and appropriate pharmacotherapy) and on improvement of symptoms (score on Patient Health Questionnaire-9 reduced by 50% or </=5). Methods: A quasi-experimental study examined data on the treatment of 2,821 patients aged 18 and older with depression symptoms between 2006 and 2009 at six community health organizations selected in a competitive process to implement a model of collaborative care. The model's key elements were use of a Web-based disease registry to track patients, care management to support primary care providers and offer proactive follow-up of patients, and organized psychiatric consultation. Results: Across all sites, a plurality of patients achieved meaningful improvement in depression, and in many sites, improvement occurred rapidly. After adjustment for patient characteristics, multivariate logistic regression models revealed significant differences across clinics in the probability of receiving early follow-up (range .34-.88) or appropriate pharmacotherapy (range .27-.69) and in experiencing improvement (.36 to .84). Similarly, after adjustment for patient characteristics, Cox proportional hazards models revealed that time elapsed between first evaluation and the occurrence of improvement differed significantly across clinics (p<.001). Conclusions: Despite receiving similar training and resources, organizations exhibited substantial variability in enacting change in clinical care systems, as evidenced by both quality indicators and outcomes. Sites that performed better on quality indicators had better outcomes, and the differences were not attributable to patients' characteristics. (Psychiatric Services 62:1047-1053, 2011).
PP - United States
PY - 2011
SN - 1557-9700; 1075-2730
SP - 1047
EP - 1053
EP - 
T1 - Implementation of collaborative depression management at community-based primary care clinics: An evaluation
T2 - Psychiatric services (Washington, D.C.)
TI - Implementation of collaborative depression management at community-based primary care clinics: An evaluation
U1 - Key & Foundational
U2 - 21885583
U3 - 10.1176/appi.ps.62.9.1047
VL - 62
VO - 1557-9700; 1075-2730
Y1 - 2011
ER -