TY - JOUR
KW - Adult
KW - Cooperative Behavior
KW - Data Collection
KW - Depression/diagnosis/therapy
KW - Electronic Health Records/statistics & numerical data
KW - Evidence-Based Medicine
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Patient Selection
KW - Primary Health Care/organization & administration
KW - Quality Improvement/organization & administration
KW - Reproducibility of Results
KW - Time Factors
AU - Lauren Crain
AU - L. I. Solberg
AU - J. Unutzer
AU - K. A. Ohnsorg
AU - M. V. Maciosek
AU - R. R. Whitebird
AU - A. Beck
AU - B. A. Molitor
A1 - 
AB - OBJECTIVE: To demonstrate a rigorous methodology that optimally balanced internal validity with generalizability to evaluate a statewide collaborative that implemented an evidence-based, collaborative care model for depression management in primary care. STUDY DESIGN AND SETTING: Several operational features of the DIAMOND (Depression Improvement Across Minnesota, Offering a New Direction) Initiative suggested that the DIAMOND Study use a staggered implementation design with repeated cross-sections of patients across clinical settings. A multilevel recruitment strategy elicited virtually complete study participation from the medical groups, clinics, and health plans that coordinated efforts to deliver and reimburse DIAMOND care. Patient identification capitalized on large health plan claims databases to rapidly identify the population of patients newly treated for depression in DIAMOND clinics. RESULTS: The staggered implementation design and multilevel recruitment strategy made it possible to evaluate DIAMOND by holding confounding factors constant and accurately identifying an intent-to-treat population of patients treated for depression without intruding on or requiring effort from their clinics. CONCLUSIONS: Recruitment and data collection from health plans, medical groups and clinics, and patients ensured a representative, intent-to-treat sample of study-enrolled patients. Separating patient identification from care delivery reduced threats of selection bias and enabled comparisons between the treated population and study sample. A key challenge is that intent-to-treat patients may not be exposed to DIAMOND which dilutes the effect size but offers realistic expectations of the impact of quality improvement in a population of treated patients.
BT - Medical care
C5 - HIT & Telehealth
CP - 9
CY - United States
DO - 10.1097/MLR.0b013e318249d8a4
IS - 9
JF - Medical care
N2 - OBJECTIVE: To demonstrate a rigorous methodology that optimally balanced internal validity with generalizability to evaluate a statewide collaborative that implemented an evidence-based, collaborative care model for depression management in primary care. STUDY DESIGN AND SETTING: Several operational features of the DIAMOND (Depression Improvement Across Minnesota, Offering a New Direction) Initiative suggested that the DIAMOND Study use a staggered implementation design with repeated cross-sections of patients across clinical settings. A multilevel recruitment strategy elicited virtually complete study participation from the medical groups, clinics, and health plans that coordinated efforts to deliver and reimburse DIAMOND care. Patient identification capitalized on large health plan claims databases to rapidly identify the population of patients newly treated for depression in DIAMOND clinics. RESULTS: The staggered implementation design and multilevel recruitment strategy made it possible to evaluate DIAMOND by holding confounding factors constant and accurately identifying an intent-to-treat population of patients treated for depression without intruding on or requiring effort from their clinics. CONCLUSIONS: Recruitment and data collection from health plans, medical groups and clinics, and patients ensured a representative, intent-to-treat sample of study-enrolled patients. Separating patient identification from care delivery reduced threats of selection bias and enabled comparisons between the treated population and study sample. A key challenge is that intent-to-treat patients may not be exposed to DIAMOND which dilutes the effect size but offers realistic expectations of the impact of quality improvement in a population of treated patients.
PP - United States
PY - 2013
SN - 1537-1948; 0025-7079
EP - 66
EP - e58+
T1 - Designing and implementing research on a statewide quality improvement initiative: the DIAMOND study and initiative
T2 - Medical care
TI - Designing and implementing research on a statewide quality improvement initiative: the DIAMOND study and initiative
U1 - HIT & Telehealth
U2 - 22322100
U3 - 10.1097/MLR.0b013e318249d8a4
VL - 51
VO - 1537-1948; 0025-7079
Y1 - 2013
ER -