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The effects of quality improvement for depression in primary care at nine years: results from a randomized, controlled group-level trial.

ABSTRACT: To examine 9-year outcomes of implementation of short-term quality improvement (QI) programs for depression in primary care.Depressed primary care patients from six U.S. health care organizations.Group-level, randomized controlled trial.Patients were randomly assigned to short-term QI programs supporting education and resources for medication management (QI-Meds) or access to evidence-based psychotherapy (QI-Therapy); and usual care (UC). Of 1,088 eligible patients, 805 (74 percent) completed 9-year follow-up; results were extrapolated to 1,269 initially enrolled and living. Outcomes were psychological well-being (Mental Health Inventory, five-item version [MHI5]), unmet need, services use, and intermediate outcomes.At 9 years, there were no overall intervention status effects on MHI5 or unmet need (largest F (2,41)=2.34, p=.11), but relative to UC, QI-Meds worsened MHI5, reduced effectiveness of coping and among whites lowered tangible social support (smallest t(42)=2.02, p=.05). The interventions reduced outpatient visits and increased perceived barriers to care among whites, but reduced attitudinal barriers due to racial discrimination and other factors among minorities (smallest F (2,41)=3.89, p=.03).Main intervention effects were over but the results suggest some unintended negative consequences at 9 years particularly for the medication-resource intervention and shifts to greater perceived barriers among whites yet reduced attitudinal barriers among minorities.

SUBMITTER: Wells KB

PROVIDER: S-EPMC2614007 | biostudies-other | 2008 Dec

REPOSITORIES: biostudies-other

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The effects of quality improvement for depression in primary care at nine years: results from a randomized, controlled group-level trial.

Wells Kenneth B KB Tang Lingqi L Miranda Jeanne J Benjamin Bernadette B Duan Naihua N Sherbourne Cathy D CD

Health services research 20080603 6

<h4>Objective</h4>To examine 9-year outcomes of implementation of short-term quality improvement (QI) programs for depression in primary care.<h4>Data sources</h4>Depressed primary care patients from six U.S. health care organizations.<h4>Study design</h4>Group-level, randomized controlled trial.<h4>Data collection</h4>Patients were randomly assigned to short-term QI programs supporting education and resources for medication management (QI-Meds) or access to evidence-based psychotherapy (QI-Ther ...[more]

PMID: 18522664

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Project description:BackgroundDissemination is a critical facet of implementing quality improvement in organizations. As a field, addiction treatment has produced effective interventions but disseminated them slowly and reached only a fraction of people needing treatment. This study investigates four methods of disseminating quality improvement (QI) to addiction treatment programs in the U.S. It is, to our knowledge, the largest study of organizational change ever conducted in healthcare. The trial seeks to determine the most cost-effective method of disseminating quality improvement in addiction treatment.MethodsThe study is evaluating the costs and effectiveness of different QI approaches by randomizing 201 addiction-treatment programs to four interventions. Each intervention used a web-based learning kit plus monthly phone calls, coaching, face-to-face meetings, or the combination of all three. Effectiveness is defined as reducing waiting time (days between first contact and treatment), increasing program admissions, and increasing continuation in treatment. Opportunity costs will be estimated for the resources associated with providing the services.OutcomesThe study has three primary outcomes: waiting time, annual program admissions, and continuation in treatment. Secondary outcomes include: voluntary employee turnover, treatment completion, and operating margin. We are also seeking to understand the role of mediators, moderators, and other factors related to an organization's success in making changes.AnalysisWe are fitting a mixed-effect regression model to each program's average monthly waiting time and continuation rates (based on aggregated client records), including terms to isolate state and intervention effects. Admissions to treatment are aggregated to a yearly level to compensate for seasonality. We will order the interventions by cost to compare them pair-wise to the lowest cost intervention (monthly phone calls). All randomized sites with outcome data will be included in the analysis, following the intent-to-treat principle. Organizational covariates in the analysis include program size, management score, and state.DiscussionThe study offers seven recommendations for conducting a large-scale cluster-randomized trial: provide valuable services, have aims that are clear and important, seek powerful allies, understand the recruiting challenge, cultivate commitment, address turnover, and encourage rigor and flexibility.Trial registrationClinicalTrials. govNCT00934141.

Dataset Information

The effects of quality improvement for depression in primary care at nine years: results from a randomized, controlled group-level trial.

Publications

The effects of quality improvement for depression in primary care at nine years: results from a randomized, controlled group-level trial.

Similar Datasets

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