Implementation and maintenance of quality improvement for treating depression in primary care.
OBJECTIVE
Little is known about the long-term success of quality improvement efforts for the treatment of depression in primary care. This study assessed factors associated with the successful implementation, maintenance, and spread of such efforts.


METHODS
The authors conducted an independent process evaluation of data from monthly progress reports and 18-month telephone interviews from multidisciplinary quality improvement teams in 17 diverse primary care organizations that participated in the Institute for Healthcare Improvement's Breakthrough Series for Depression from February 2000 through March 2001.


RESULTS
All sites made changes toward improving care in three of six categories: delivery system redesign, self-management strategies, and information systems. The changes that were most commonly viewed as major successes were delivery system changes (ten sites, or 59 percent) and information system changes (nine sites, or 53 percent); these types of changes were also the most often sustained over time (ten sites, or 59 percent, and 16 sites, or 94 percent, respectively). Fifteen sites made changes in decision support, community linkages, and health system support but were less likely to view these changes as major successes or to sustain them. Organizational structure and leadership support were the most common facilitators. Staff resistance, time constraints, and information technology were the most common barriers. Implementation strategies varied with sets of barriers.


CONCLUSIONS
Despite substantial challenges, there was evidence of broad success at implementation and maintenance of quality improvement for depression treatment in primary care.
Meredith
Lisa S
LS
RAND Corporation, Santa Monica, California 90407-2138, USA. lisa_meredith@rand.org
Mendel
Peter
P
Pearson
Marjorie
M
Wu
Shin-Yi
SY
Joyce
Geoffrey
G
Straus
Julie B
JB
Ryan
Gery
G
Keeler
Emmett
E
Unützer
Jürgen
J
D003866:Depressive Disorder / Q000628:therapy*; D006304:Health Status; D006801:Humans; D001523:Mental Disorders / Q000628:therapy; D008605:Mental Health Services / Q000592:standards*; D009936:Organizational Innovation; D011320:Primary Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D014481:United States