Collaborative care for bipolar disorder: part I. Intervention and implementation in a randomized effectiveness trial.
Outcome for bipolar disorder remains suboptimal despite the availability of efficacious treatments. To improve treatment effectiveness in clinical practice, a Veterans Affairs study team created a care model conceptually similar to the lithium clinics of the 1970s but augmented by principles of more recent collaborative care models for chronic medical illnesses. This intervention consists of improving patients' self-management skills through psychoeducation; supporting providers' decision making through simplified practice guidelines; and enhancing access to care, continuity of care, and information flow through the use of a nurse care coordinator. In this article, which is part I of a two-part report, the authors summarize the conceptual background and development of the intervention, describe the design of a three-year, 11-site randomized effectiveness trial, and report data describing its successful implementation. Trial design emphasized aspects of effectiveness to support generalizability of the findings and eventual dissemination of the intervention. Part II (see companion article, this issue) reports clinical, functional, and overall cost outcomes of the trial.
Bauer
Mark S
MS
Providence Veterans Affairs Medical Center (VANC), Rhode Island 02908-4799, USA. mark.bauer@med.va.gov
McBride
Linda
L
Williford
William O
WO
Glick
Henry
H
Kinosian
Bruce
B
Altshuler
Lori
L
Beresford
Thomas
T
Kilbourne
Amy M
AM
Sajatovic
Martha
M
D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D019090:Case Management / Q000191:economics; D002908:Chronic Disease; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000191:economics; D003266:Continuity of Patient Care / Q000191:economics; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis / Q000191:economics; D019033:Delivery of Health Care, Integrated / Q000191:economics; D005260:Female; D006284:Health Plan Implementation / Q000191:economics; D006297:Health Services Accessibility / Q000191:economics; D006787:Hospitals, Veterans / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000191:economics; D010353:Patient Education as Topic / Q000191:economics; D010359:Patient Readmission / Q000191:economics; D017410:Practice Guidelines as Topic; D012648:Self Care / Q000191:economics; D016896:Treatment Outcome; D014481:United States; D014728:Veterans / Q000523:psychology*