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 Solberg, Leif I. A1 Crain, A. Lauren A1 Maciosek, Michael V. A1 Unützer, Jürgen A1 Ohnsorg, Kris A. A1 Beck, Arne A1 Rubenstein, Lisa A1 Whitebird, Robin R. A1 Rossom, Rebecca C. A1 Pietruszewski, Pamela B. A1 Crabtree, Benjamin F. A1 Joslyn, Kenneth A1 Van de Ven, Andrew A1 Glasgow, Russell E. 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.