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Going to Scale: Re-Engineering Systems for Primary Care Treatment of Depression

¹ Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH
² Center for Health Services Research in Primary Care and the Division of General Internal Medicine, Durham Veterans Affairs Medical Center and Duke University, Durham, NC
³ Regenstrief Institute for Health Care and Indiana University School of Medicine, Indianapolis, Ind
⁴ Weill Medical College of Cornell University, White Plains, NY

CORRESPONDING AUTHOR: Allen J. Dietrich, MD, Department of Community and Family Medicine, HB 7250, Dartmouth Medical School, Hanover, NH 03755. allen.dietrich{at}dartmouth.edu

BACKGROUND Recent trials have shown improved depression outcomes with chronic care models. We report the methods of a project that assesses the sustainability and transportability of a chronic care model for depression and change strategy.

METHODS In a randomized controlled trial (RCT), a clinical model for depression was implemented through a strategy supporting practice change. The clinical model is evidence based. The change strategy relies on established quality improvement programs and is informed by diffusion of innovations theory. Evaluation will address patient outcomes, as well as process of care and process of change.

RESULTS Five medical groups and health plans are participating in the trial. The RCT involves 180 clinicians in 60 practices. All practices assigned to the clinical model have implemented it. Participating organizations have the potential to disseminate this clinical model of care to 700 practices and 1,700 clinicians.

CONCLUSIONS It is feasible to implement the clinical model and change strategy in diverse practices. Follow-up evaluation will determine the impact, sustainability, and potential for dissemination. Materials are available through http://www.depression-primarycare.org; more in-depth descriptions of the clinical model and change strategy are available in the online-only appendixes to this article.

Key Words: Depression • depressive disorder • health services research, program evaluation • primary health care • information dissemination • randomized controlled trials

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