TY - JOUR
KW - Adolescent
KW - Adult
KW - Depression/therapy
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Mental Health Services/organization & administration
KW - Middle Aged
KW - Outcome Assessment (Health Care)
KW - Primary Health Care/organization & administration
KW - Washington
KW - Young Adult
AU - Y. Bao
AU - B. G. Druss
AU - H . Y. Jung
AU - Y. F. Chan
AU - J. Unutzer
A1 - 
AB - OBJECTIVE: This study examined how two key process-of-care tasks of the collaborative care model (CCM) predict patient depression outcomes. METHODS: Registry data were from a large implementation of the CCM in Washington State and included 5,439 patient-episodes for patients age 18 or older with a baseline Patient Health Questionnaire-9 (PHQ-9) score of >/=10 and at least one follow-up contact with the CCM care manager within 24 weeks of initial contact. Key CCM tasks examined were at least one care manager follow-up contact within four weeks of initial contact and at least one psychiatric consultation between weeks 8 and 12 for patients not responding to treatment by week 8. Clinically significant improvement in depression symptoms was defined as achieving a PHQ-9 score of <10 or a 50% or more reduction in PHQ-9 score compared with baseline. Bivariate and multivariate (logistic and proportional hazard models) analyses were conducted to examine how fidelity with either task predicted outcomes. All analyses were conducted with the original sample and with a propensity score-matched sample. RESULTS: Four-week follow-up was associated with a greater likelihood of achieving improvement in depression (odds ratio [OR]=1.63, 95% confidence interval [CI]=1.23-2.17) and a shorter time to improvement (hazard ratio=2.06, CI=1.67-2.54). Psychiatric consultation was also associated with a greater likelihood of improvement (OR=1.44, CI=1.13-1.84) but not with a shorter time to improvement. Propensity score-matched analysis yielded very similar results. CONCLUSIONS: Findings support efforts to improve fidelity to the two process-of-care tasks and to include these tasks among quality measures for CCM implementation.
BT - Psychiatric services (Washington, D.C.)
C5 - Education & Workforce
CP - 4
CY - United States
DO - 10.1176/appi.ps.201400577
IS - 4
JF - Psychiatric services (Washington, D.C.)
N2 - OBJECTIVE: This study examined how two key process-of-care tasks of the collaborative care model (CCM) predict patient depression outcomes. METHODS: Registry data were from a large implementation of the CCM in Washington State and included 5,439 patient-episodes for patients age 18 or older with a baseline Patient Health Questionnaire-9 (PHQ-9) score of >/=10 and at least one follow-up contact with the CCM care manager within 24 weeks of initial contact. Key CCM tasks examined were at least one care manager follow-up contact within four weeks of initial contact and at least one psychiatric consultation between weeks 8 and 12 for patients not responding to treatment by week 8. Clinically significant improvement in depression symptoms was defined as achieving a PHQ-9 score of <10 or a 50% or more reduction in PHQ-9 score compared with baseline. Bivariate and multivariate (logistic and proportional hazard models) analyses were conducted to examine how fidelity with either task predicted outcomes. All analyses were conducted with the original sample and with a propensity score-matched sample. RESULTS: Four-week follow-up was associated with a greater likelihood of achieving improvement in depression (odds ratio [OR]=1.63, 95% confidence interval [CI]=1.23-2.17) and a shorter time to improvement (hazard ratio=2.06, CI=1.67-2.54). Psychiatric consultation was also associated with a greater likelihood of improvement (OR=1.44, CI=1.13-1.84) but not with a shorter time to improvement. Propensity score-matched analysis yielded very similar results. CONCLUSIONS: Findings support efforts to improve fidelity to the two process-of-care tasks and to include these tasks among quality measures for CCM implementation.
PP - United States
PY - 2016
SN - 1557-9700; 1075-2730
SP - 418
EP - 424
EP - 
T1 - Unpacking Collaborative Care for Depression: Examining Two Essential Tasks for Implementation
T2 - Psychiatric services (Washington, D.C.)
TI - Unpacking Collaborative Care for Depression: Examining Two Essential Tasks for Implementation
U1 - Education & Workforce
U2 - 26567934
U3 - 10.1176/appi.ps.201400577
VL - 67
VO - 1557-9700; 1075-2730
Y1 - 2016
ER -