Going to scale: re-engineering systems for primary care treatment of depression.
BACKGROUND
Recent trials have shown improved depression outcomes with chronic care models. We report the methods of a project that assesses the sustainability and transportability of a chronic care model for depression and change strategy.


METHODS
In a randomized controlled trial (RCT), a clinical model for depression was implemented through a strategy supporting practice change. The clinical model is evidence based. The change strategy relies on established quality improvement programs and is informed by diffusion of innovations theory. Evaluation will address patient outcomes, as well as process of care and process of change.


RESULTS
Five medical groups and health plans are participating in the trial. The RCT involves 180 clinicians in 60 practices. All practices assigned to the clinical model have implemented it. Participating organizations have the potential to disseminate this clinical model of care to 700 practices and 1,700 clinicians.


CONCLUSIONS
It is feasible to implement the clinical model and change strategy in diverse practices. Follow-up evaluation will determine the impact, sustainability, and potential for dissemination. Materials are available through http://www. depression-primarycare.org; more in-depth descriptions of the clinical model and change strategy are available in the online-only appendixes to this article.
Dietrich
Allen J
AJ
Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03755, USA. allen.dietrich@dartmouth.edu
Oxman
Thomas E
TE
Williams
John W
JW
Kroenke
Kurt
K
Schulberg
H Charles
HC
Bruce
Martha
M
Barry
Sheila L
SL
D003299:Cooperative Behavior; D003863:Depression / Q000628:therapy*; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration; D008962:Models, Theoretical; D010819:Physician's Role; D011320:Primary Health Care / Q000458:organization & administration*; D016032:Randomized Controlled Trials as Topic; D013598:Systems Theory