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

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

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.

MeSH terms

  • Cooperative Behavior*
  • Depressive Disorder, Major / therapy*
  • Evidence-Based Practice
  • Humans
  • Information Systems
  • Inservice Training / organization & administration
  • Mental Health Services / organization & administration*
  • Patient Care Management / organization & administration
  • Primary Health Care / organization & administration*
  • Quality Assurance, Health Care / organization & administration*
  • Translational Medical Research / organization & administration
  • United States
  • United States Department of Veterans Affairs / organization & administration