Implementation and Maintenance of Quality Improvement for Treating Depression in Primary Care

Meredith, Lisa S.; Mendel, Peter; Pearson, Marjorie L.; Wu, Shinyi; Joyce, Geoffrey F.; Straus, Julie B.; Ryan, Gery W.; Keeler, Emmett B.; Unützer, Jürgen

doi:10.1176/appi.ps.57.1.48

Cited by 88 publications

(135 citation statements)

References 30 publications

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“…Despite these difficulties, other research we have participated in has demonstrated that it is possible to reliably measure the intensity of implementation across a range of health conditions, including depression and other illnesses , and to systematically relate these indicators to implementation effectiveness both descriptively (Meredith et al 2006) and predictively (Shortell et al 2004). We intend to extend such techniques to studies in the center based on more participatory-oriented research designs, and are particularly looking to this framework to assist in integrating these kinds of data and analysis.…”

Section: Measurement and Analysismentioning

confidence: 99%

Interventions in Organizational and Community Context: A Framework for Building Evidence on Dissemination and Implementation in Health Services Research

Mendel

Meredith

Schoenbaum

et al. 2007

Adm Policy Ment Health

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309

352

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The effective dissemination and implementation of evidence-based health interventions within community settings is an important cornerstone to expanding the availability of quality health and mental health services. Yet it has proven a challenging task for both research and community stakeholders. This paper presents the current framework developed by the UCLA/RAND NIMH Center to address this research-to-practice gap by: 1) providing a theoretically-grounded understanding of the multi-layered nature of community and healthcare contexts and the mechanisms by which new practices and programs diffuse within these settings; 2) distinguishing among key components of the diffusion process-including contextual factors, adoption, implementation, and sustainment of interventions-showing how evaluation of each is necessary to explain the course of dissemination and outcomes for individual and organizational stakeholders; 3) facilitating the identification of new strategies for adapting, disseminating, and implementing relatively complex, evidence-based healthcare and improvement interventions, particularly using a community-based, participatory approach; and 4) enhancing the ability to meaningfully generalize findings across varied interventions and settings to build an evidence base on successful dissemination and implementation strategies.

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Section: Measurement and Analysismentioning

confidence: 99%

Interventions in Organizational and Community Context: A Framework for Building Evidence on Dissemination and Implementation in Health Services Research

Mendel

Meredith

Schoenbaum

et al. 2007

Adm Policy Ment Health

Self Cite

309

352

View full text Add to dashboard Cite

show abstract

“…It seems that by working together they were able to overcome some of the challenges associated with change efforts, such as a lack of leadership, 27 limited organizational support for improvement, 9,12,27,28 the need for ongoing communication, 29 and the limited involvement of all members of a patient care continuum in the quality improvement efforts. 27,30 The learning sessions raised the awareness of both coleaders to the difficulty of making and sustaining change and provided them with tools to address resistance to change in their practices.…”

Section: Discussionmentioning

confidence: 99%

It Takes Two: Using Coleaders to Champion Improvements in Small Primary Care Practices

Gallagher¹,

Nutting²,

Nease³

et al. 2010

The Journal of the American Board of Family Medicine

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Background: Making the kind of improvement changes necessary to move toward a patient-centered medical home will continue to challenge small, independent primary care practices. Here we describe further analysis of a successful program to understand the roles of coleaders of a change management process.Methods: Through an improvement collaborative we trained 2 coleaders (a physician and a non-physician) from 16 small primary care practices to institute depression care improvements. These coleaders participated in 3 learning sessions that provided depression care content as well as skills to implement a change management strategy. Qualitative data were collected by observation during the learning sessions and through in-depth interviews conducted at baseline, between each learning session, at the end of the project, 6 months after the project ended, and, finally, 26 months after the project's end.Results: Interview results with the coleaders affirmed that a team approach is a viable strategy for practice improvement. The 2 coleaders used their complementary skills, relationships, and credibility among the practice staff to implement and sustain practice improvements. In their differing roles, they varied in how they perceived barriers to change and how they assessed their team's progress.Conclusions: Involving both a physician and a non-physician as coleaders enables improvement teams in small primary care practices to make progress both in the clinical content of their work and in the critical change management activities involved with creating a team, managing meetings, and coordinating work between meetings. Using a coleader structure enriches the improvement process, broadens participation in the change process, and helps to sustain these efforts over time.

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“…Practice-Based Collaborative Care (PBCC)-The PBCC intervention was designed to be the same as the model of care supported by HRSA, known as the Depression Health Disparities Collaborative, 34,35 and represents more intensive treatment than usual care. PBCC involved two types of providers: on-site PC providers and on-site nurse depression care managers (DCM).…”

Section: Randomization and Interventionsmentioning

confidence: 99%

Practice-Based Versus Telemedicine-Based Collaborative Care for Depression in Rural Federally Qualified Health Centers: A Pragmatic Randomized Comparative Effectiveness Trial

Fortney

Pyne

Mouden

et al. 2017

FOC

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Objective-Practice Based Collaborative Care is a complex evidence-based practice that is difficult to implement in smaller primary care practices lacking on-site mental health staff. Telemedicine Based Collaborative Care virtually co-locates and integrates mental health providers into primary care settings. The objective of this multi-site randomized pragmatic comparative effectiveness trial was to compare the outcomes of patients randomized to Practice Based versus Telemedicine Based Collaborative Care. [2007][2008][2009], patients at Federally Qualified Health Centers serving medically underserved populations were screened for depression, and 364 patients screening positive were enrolled and followed for 18 months. Those randomized to Practice Based Collaborative Care received evidence-based care from an on-site primary care provider and nurse care manager. Those randomized to Telemedicine Based Collaborative Care received evidence-based care from an on-site primary care provider and off-site telephone nurse care manager, telephone pharmacist, tele-psychologist and tele-psychiatrist. The primary clinical outcomes were treatment response, remission and changes in depression severity Results-There were significant group main effects for both response (OR=7.74, CI 95 =3. p<0.0001) and remission (OR=12.69, p<0.0001) and a significant overall group by time interaction effect for Hopkins Symptom Checklist depression severity ( 2 3 =40.51, p<0.0001) with greater reductions in depression severity observed over time for those randomized to Telemedicine Based Collaborative Care. Improvements in outcomes appeared to be attributable to higher fidelity to the collaborative care evidence-base in the Telemedicine Based group. Method-FromConclusions-Contracting with an off-site Telemedicine Based Collaborative Care team yields better outcomes than implementing Practice Based Collaborative Care with locally available staff.

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Implementation and Maintenance of Quality Improvement for Treating Depression in Primary Care

Abstract: Despite substantial challenges, there was evidence of broad success at implementation and maintenance of quality improvement for depression treatment in primary care.

Cited by 88 publications

References 30 publications

Interventions in Organizational and Community Context: A Framework for Building Evidence on Dissemination and Implementation in Health Services Research

Interventions in Organizational and Community Context: A Framework for Building Evidence on Dissemination and Implementation in Health Services Research

It Takes Two: Using Coleaders to Champion Improvements in Small Primary Care Practices

Practice-Based Versus Telemedicine-Based Collaborative Care for Depression in Rural Federally Qualified Health Centers: A Pragmatic Randomized Comparative Effectiveness Trial

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