 |
|
Five-Year Impact of Quality Improvement for Depression
Results of a Group-Level Randomized Controlled Trial
Kenneth Wells, MD, MPH;
Cathy Sherbourne, PhD;
Michael Schoenbaum, PhD;
Susan Ettner, PhD;
Naihua Duan, PhD;
Jeanne Miranda, PhD;
Jürgen Unützer, MD, MPH;
Lisa Rubenstein, MD, MSHS
Arch Gen Psychiatry. 2004;61:378-386.
Background Quality improvement (QI) programs for depressed primary care patients can improve health outcomes for 6 to 28 months; effects for longer than 28 months are unknown.
Objective To assess how QI for depression affects health outcomes, quality of care, and health outcome disparities at 57-month follow-up.
Design A group-level randomized controlled trial.
Setting Forty-six primary care practices in 6 managed care organizations.
Patients Of 1356 primary care patients who screened positive for depression and enrolled in the trial, 991 (73%, including 451 Latinos and African Americans) completed 57-month telephone follow-up.
Interventions Clinics were randomly assigned to usual care or to 1 of 2 QI programs supporting QI teams, provider training, nurse assessment, and patient education, plus resources to support medication management (QI-meds) or psychotherapy (QI-therapy) for 6 to 12 months.
Main Outcome Measures Probable depressive disorder in the previous 6 months, mental health–related quality of life in the previous 30 days, primary care or mental health specialty visits, counseling or antidepressant medications in the previous 6 months, and unmet need, defined as depressed but not receiving appropriate care.
Results Combined QI-meds and QI-therapy, relative to usual care, reduced the percentage of participants with probable disorder at 5 years by 6.6 percentage points (P = .04). QI-therapy improved health outcomes and reduced unmet need for appropriate care among Latinos and African Americans combined but provided few long-term benefits among whites, reducing outcome disparities related to usual care (P = .04 for QI-ethnicity interaction for probable depressive disorder).
Conclusions Programs for QI for depressed primary care patients implemented by managed care practices can improve health outcomes 5 years after implementation and reduce health outcome disparities by markedly improving health outcomes and unmet need for appropriate care among Latinos and African Americans relative to whites; thus, equity was improved in the long run.
From the Health Program, RAND, Santa Monica, Calif (Drs Wells, Sherbourne, Schoenbaum, and Rubenstein); the Neuropsychiatric Institute (Drs Wells, Duan, Miranda, and Unützer), the Departments of Psychiatry and Biobehavioral Services (Drs Wells, Duan, Miranda, and Unützer) and Biostatistics (Dr Duan), the Health Services Research Center (Drs Wells, Duan, Miranda, and Unützer), and the Center for Community Health (Dr Duan), University of California at Los Angeles; University of California at Los Angeles Department of Medicine, Division of General Internal Medicine and Health Services Research (Drs Ettner and Rubenstein); and the Department of Medicine, VA Greater Los Angeles Healthcare System, Sepulveda, Calif (Dr Rubenstein).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
New Evidence Regarding Racial And Ethnic Disparities In Mental Health: Policy Implications
McGuire and Miranda
Health Aff (Millwood) 2008;27:393-403.
ABSTRACT
| FULL TEXT
Improving Child and Parent Mental Health in Primary Care: A Cluster-Randomized Trial of Communication Skills Training
Wissow et al.
Pediatrics 2008;121:266-275.
ABSTRACT
| FULL TEXT
Racial and Ethnic Disparities in the Quality of Asthma Care
Cabana et al.
Chest 2007;132:810S-817S.
ABSTRACT
| FULL TEXT
Cost-Effectiveness of Quality Improvement Programs for Patients With Subthreshold Depression or Depressive Disorder
Wells et al.
Psychiatr. Serv. 2007;58:1269-1278.
ABSTRACT
| FULL TEXT
Reducing the Burden of Depression: Building Villages for Coordinated Care
Wells and Miranda
JAMA 2007;298:1451-1452.
FULL TEXT
The Roles of Counseling Psychologists in Reducing Health Disparities
Tucker et al.
The Counseling Psychologist 2007;35:650-678.
ABSTRACT
A Systematic Review of Depression Treatments in Primary Care for Latino Adults
Cabassa and Hansen
Research on Social Work Practice 2007;17:494-503.
ABSTRACT
Performance measurement and equity
Bierman and Clark
BMJ 2007;334:1333-1334.
FULL TEXT
Collaborative care for depression in primary care: Making sense of a complex intervention: systematic review and meta-regression
Bower et al.
Br. J. Psychiatry 2006;189:484-493.
ABSTRACT
| FULL TEXT
Collaborative Care for Depression: A Cumulative Meta-analysis and Review of Longer-term Outcomes
Gilbody et al.
Arch Intern Med 2006;166:2314-2321.
ABSTRACT
| FULL TEXT
Costs and consequences of enhanced primary care for depression: Systematic review of randomised economic evaluations
GILBODY et al.
Br. J. Psychiatry 2006;189:297-308.
ABSTRACT
| FULL TEXT
What is necessary to transform the quality of mental health care.
Patel et al.
Health Aff (Millwood) 2006;25:681-693.
ABSTRACT
| FULL TEXT
Effect of quality improvement on racial disparities in diabetes care.
Sequist et al.
Arch Intern Med 2006;166:675-681.
ABSTRACT
| FULL TEXT
Transforming Mental Health Care at the Interface With General Medicine: Report for the Presidents Commission
Unutzer et al.
Psychiatr. Serv. 2006;57:37-47.
ABSTRACT
| FULL TEXT
Improving Care for Depression in Patients With Comorbid Substance Misuse
Watkins et al.
Am. J. Psychiatry 2006;163:125-132.
ABSTRACT
| FULL TEXT
The Current State of Cognitive Therapy: A 40-Year Retrospective
Beck
Arch Gen Psychiatry 2005;62:953-959.
ABSTRACT
| FULL TEXT
Quality Improvement for Depression in Primary Care: Do Patients With Subthreshold Depression Benefit in the Long Run?
Wells et al.
Am. J. Psychiatry 2005;162:1149-1157.
ABSTRACT
| FULL TEXT
Depression In Primary Care: Bringing Behavioral Health Care Into The Mainstream
Pincus et al.
Health Aff (Millwood) 2005;24:271-276.
ABSTRACT
| FULL TEXT
Learning from low income countries: mental health
McKenzie et al.
BMJ 2004;329:1138-1140.
FULL TEXT
Depression: Quality Improvement Works and Lasts
JWatch Women's Health 2004;2004:10-10.
FULL TEXT
|
