RT Journal Article
SR Electronic
T1 A Stepped-Wedge Evaluation of an Initiative to Spread the Collaborative Care Model for Depression in Primary Care
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 412
OP 420
DO 10.1370/afm.1842
VO 13
IS 5
A1 Leif I. Solberg
A1 A. Lauren Crain
A1 Michael V. Maciosek
A1 Jürgen Unützer
A1 Kris A. Ohnsorg
A1 Arne Beck
A1 Lisa Rubenstein
A1 Robin R. Whitebird
A1 Rebecca C. Rossom
A1 Pamela B. Pietruszewski
A1 Benjamin F. Crabtree
A1 Kenneth Joslyn
A1 Andrew Van de Ven
A1 Russell E. Glasgow
YR 2015
UL http://www.annfammed.org/content/13/5/412.abstract
AB PURPOSE Scale-up and spread of evidence-based practices is one of the most important challenges facing health care. We tested whether a statewide initiative, Depression Improvement Across Minnesota–Offering a New Direction (DIAMOND), to implement the collaborative care model for depression in 75 primary care clinics resulted in patient outcome improvements corresponding to those reported in randomized controlled trials.METHODS Health plans provided a new monthly payment to participating clinics after a 6-month intensive training program with ongoing data submission, networking, and consultation. Implementation was staggered, with 5 sequences of 10 to 40 clinics every 6 months. Payers provided weekly contact information for members from participating clinics who were filling antidepressant prescriptions, and we conducted baseline and 6-month surveys of 1,578 patients about their care and outcomes.RESULTS There were 466 patients in DIAMOND clinics who received usual care before implementation (UCB), 559 who received usual care in DIAMOND clinics after implementation (UCA), 245 who received DIAMOND care after implementation (DCA), and 308 who received usual care in comparison clinics (UC). Patients who received DIAMOND care after implementation reported more collaborative care depression services than the 3 comparison groups (10.9 vs 6.4–6.7, on a scale of 0 of 14, where higher numbers indicate more services; P <.001) and more satisfaction with their care (4.0 vs 3.4 on a scale 1 to 5, in which higher scores indicate higher satisfaction; P ≤.001). Depression remission rates, however, were not significantly different among the 4 groups (36.4% DCA vs 35.8% UCB, 35.0% UCA, 33.9% UC; P = .94).CONCLUSIONS Despite the incentive of a supporting payment change and intensive training and support for clinics volunteering to participate, no difference in depression outcomes was documented. Specific unmeasured actions present in trials but not present in these clinics may be critical for successful outcome improvement.