Understanding team-based quality improvement for depression in primary care.
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.


METHODS
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.


METHODS
Comparative formative evaluation of the quality and duration of implementation of the depression improvement programs developed by Central Teams (CTs) emphasizing expert design and Local Teams (LTs) emphasizing participatory local clinician design, and of the effects of additional team and environmental factors on each type of team. Both types of teams depended upon local clinicians for implementation.


RESULTS
The CT intervention program designs were more evidence-based 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.
Rubenstein
Lisa V
LV
RAND Health Program, Santa Monica, CA 90401-3297, USA.
Parker
Louise E
LE
Meredith
Lisa S
LS
Altschuler
Andrea
A
dePillis
Emmeline
E
Hernandez
John
J
Gordon
Nancy P
NP
D000368:Aged; D002983:Clinical Competence; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008332:Management Quality Circles; D010348:Patient Care Team / Q000592:standards; D011320:Primary Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D011787:Quality of Health Care; D017749:Total Quality Management / Q000379:methods*; D014481:United States