Understanding Team‐based Quality Improvement for Depression in Primary Care

Abstract

Objective. To assess the impacts of the characteristics of quality improvement (QI) teams and their environments on team success in designing and implementing high quality, enduring depression care improvement programs in primary care (PC) practices.Study Setting/Data Sources. Two nonprofit managed care organizations sponsored five QI teams tasked with improving care for depression in large PC practices. Data on characteristics of the teams and their environments is from observer process notes, national expert ratings, administrative data, and interviews. Principal Findings. The CT intervention program designs were more evidencebased than those of LTs. Expert team leadership, support from local practice management, and support from local mental health specialists strongly influenced the development of successful team programs. The CTs and LTs were equally successful when these conditions could be met, but CTs were more successful than LTs in less supportive environments.Conclusions. The LT approach to QI for depression requires high local support and expertise from primary care and mental health clinicians. The CT approach is more likely to succeed than the LT approach when local practice conditions are not optimal.

Randomized Trial of Quality Improvement Intervention to Improve Diabetes Care in Primary Care Settings

“…This intervention focused on clinic leaders as the principal vector for change, but some reports suggest that change strategies driven by medical group leaders may be more effective than those driven by clinic leaders (6,28,29). Some may argue that insufficient time elapsed between the completion of training and the measure of A1C concentrations.…”

Pre-post Evaluation of Automated Reminders May Improve Detection and Management of Post-stroke Depression

“…The research team facilitated the formation of local clinical teams at both sites consisting of a provider clinical champion from neurology or PC, a nurse leader, and other staff involved in the outpatient PC and neurology clinics as identified by the clinical champions. 26 The teams met to discuss current depression screening strategies in use, special requirements for implementation of depression screening for stroke patients, adapting the existing PC depression screener (the two-item Patient Health Questionnaire, or PHQ-2), 27 and the development of a provider-specific PSD treatment reminder.…”

Comparative Health Systems Research among Kaiser Permanente and Other Integrated Delivery Systems: A Systematic Literature Review

“…13,15,17,25,36,40,47 On the basis of disease or type of condition, diabetes mellitus was the most frequently studied (n = 11). d Other conditions that were commonly studied included cardiovascular disease (n = 7), 16,17,36,40,47,66,69 mental health and substance abuse (n = 6), 26,30,32,45,57,67 and asthma/chronic obstructive pulmonary disease (n = 4). 16,22,35,68 Several themes emerged from the literature as possible factors that may contribute to improved care delivery in integrated delivery systems.…”