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Fam Syst Health. 2010 Jun;28(2):91-113. doi: 10.1037/a0020302.

Using evidence-based quality improvement methods for translating depression collaborative care research into practice.

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1
Department of Medicine and Health Services Research, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. lisa.rubenstein@va.gov

Abstract

OBJECTIVE:

Translating Initiatives in Depression into Effective Solution (TIDES) aimed to translate research-based collaborative care for depression into an approach for the Veterans Health Administration (VA). SITES: Three multistate administrative regions and seven of their medium-sized primary care practices.

INTERVENTION:

Researchers assisted regional leaders in adapting research-based depression care models using evidence-based quality improvement (EBQI) methods.

EVALUATION:

We evaluated model fidelity and impacts on patients. Trained nurse depression care managers collected data on patient adherence and outcomes.

RESULTS:

Among 72% (128) of the 178 patients followed in primary care with depression care manager assistance during the 3-year study period, mean PHQ-9 scores dropped from 15.1 to 4.7 (p < .001). A total of 87% of patients achieved a PHQ-9 score lower than 10 (no major depression). 62% achieved a score lower than six (symptom resolution). Care managers referred 28% (50) TIDES patients to mental health specialty (MHS). In the MHS-referred group, mean PHQ-9 scores dropped from 16.4 to 9.0 (p < .001). A total of 58% of MHS-referred patients achieved a PHQ-9 score lower than 10, and 40%, a score less than 6. Over the 2 years following the initial development phase reported here, national policymakers endorsed TIDES through national directives and financial support.

CONCLUSIONS:

TIDES developed an evidence-based depression collaborative care prototype for a large health care organization (VA) using EBQI methods. As expected, care managers referred sicker patients to mental health specialists; these patients also improved. Overall, TIDES achieved excellent overall patient outcomes, and the program is undergoing national spread.

PMID:
20695669
DOI:
10.1037/a0020302
[Indexed for MEDLINE]
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