TY - JOUR KW - Adult KW - Community Mental Health Services/organization & administration/standards/utilization KW - Comparative Effectiveness Research/methods KW - Cooperative Behavior KW - Depression/therapy KW - Depressive Disorder/therapy KW - Female KW - Health Care Reform/methods KW - Health Planning/organization & administration KW - Health Services Needs and Demand KW - Health Services Research/methods KW - Health Services/utilization KW - Healthcare Disparities KW - Hospitalization/statistics & numerical data KW - Humans KW - Interinstitutional Relations KW - Los Angeles KW - Male KW - Medically Underserved Area KW - Middle Aged KW - Patient Selection KW - Psychiatric Status Rating Scales KW - Quality of Life KW - Single-Blind Method KW - Socioeconomic Factors KW - Treatment Outcome AU - K. B. Wells AU - L. Jones AU - B. Chung AU - E. L. Dixon AU - L. Tang AU - J. Gilmore AU - C. Sherbourne AU - V. K. Ngo AU - M. K. Ong AU - S. Stockdale AU - E. Ramos AU - T. R. Belin AU - J. Miranda A1 - AB - BACKGROUND: Depression contributes to disability and there are ethnic/racial disparities in access and outcomes of care. Quality improvement (QI) programs for depression in primary care improve outcomes relative to usual care, but health, social and other community-based service sectors also support clients in under-resourced communities. Little is known about effects on client outcomes of strategies to implement depression QI across diverse sectors. OBJECTIVE: To compare the effectiveness of Community Engagement and Planning (CEP) and Resources for Services (RS) to implement depression QI on clients' mental health-related quality of life (HRQL) and services use. DESIGN: Matched programs from health, social and other service sectors were randomized to community engagement and planning (promoting inter-agency collaboration) or resources for services (individual program technical assistance plus outreach) to implement depression QI toolkits in Hollywood-Metro and South Los Angeles. PARTICIPANTS: From 93 randomized programs, 4,440 clients were screened and of 1,322 depressed by the 8-item Patient Health Questionnaire (PHQ-8) and providing contact information, 1,246 enrolled and 1,018 in 90 programs completed baseline or 6-month follow-up. MEASURES: Self-reported mental HRQL and probable depression (primary), physical activity, employment, homelessness risk factors (secondary) and services use. RESULTS: CEP was more effective than RS at improving mental HRQL, increasing physical activity and reducing homelessness risk factors, rate of behavioral health hospitalization and medication visits among specialty care users (i.e. psychiatrists, mental health providers) while increasing depression visits among users of primary care/public health for depression and users of faith-based and park programs (each p 0.05). CONCLUSION: Community engagement to build a collaborative approach to implementing depression QI across diverse programs was more effective than resources for services for individual programs in improving mental HRQL, physical activity and homelessness risk factors, and shifted utilization away from hospitalizations and specialty medication visits toward primary care and other sectors, offering an expanded health-home model to address multiple disparities for depressed safety-net clients. BT - Journal of general internal medicine C5 - General Literature CP - 10 CY - United States DO - 10.1007/s11606-013-2484-3 IS - 10 JF - Journal of general internal medicine N2 - BACKGROUND: Depression contributes to disability and there are ethnic/racial disparities in access and outcomes of care. Quality improvement (QI) programs for depression in primary care improve outcomes relative to usual care, but health, social and other community-based service sectors also support clients in under-resourced communities. Little is known about effects on client outcomes of strategies to implement depression QI across diverse sectors. OBJECTIVE: To compare the effectiveness of Community Engagement and Planning (CEP) and Resources for Services (RS) to implement depression QI on clients' mental health-related quality of life (HRQL) and services use. DESIGN: Matched programs from health, social and other service sectors were randomized to community engagement and planning (promoting inter-agency collaboration) or resources for services (individual program technical assistance plus outreach) to implement depression QI toolkits in Hollywood-Metro and South Los Angeles. PARTICIPANTS: From 93 randomized programs, 4,440 clients were screened and of 1,322 depressed by the 8-item Patient Health Questionnaire (PHQ-8) and providing contact information, 1,246 enrolled and 1,018 in 90 programs completed baseline or 6-month follow-up. MEASURES: Self-reported mental HRQL and probable depression (primary), physical activity, employment, homelessness risk factors (secondary) and services use. RESULTS: CEP was more effective than RS at improving mental HRQL, increasing physical activity and reducing homelessness risk factors, rate of behavioral health hospitalization and medication visits among specialty care users (i.e. psychiatrists, mental health providers) while increasing depression visits among users of primary care/public health for depression and users of faith-based and park programs (each p 0.05). CONCLUSION: Community engagement to build a collaborative approach to implementing depression QI across diverse programs was more effective than resources for services for individual programs in improving mental HRQL, physical activity and homelessness risk factors, and shifted utilization away from hospitalizations and specialty medication visits toward primary care and other sectors, offering an expanded health-home model to address multiple disparities for depressed safety-net clients. PP - United States PY - 2013 SN - 1525-1497; 0884-8734 SP - 1268 EP - 1278 EP - T1 - Community-partnered cluster-randomized comparative effectiveness trial of community engagement and planning or resources for services to address depression disparities T2 - Journal of general internal medicine TI - Community-partnered cluster-randomized comparative effectiveness trial of community engagement and planning or resources for services to address depression disparities U1 - General Literature U2 - 23649787 U3 - 10.1007/s11606-013-2484-3 VL - 28 VO - 1525-1497; 0884-8734 Y1 - 2013 ER -