The cumulative effects of quality improvement for depression on outcome disparities over 9 years: results from a randomized, controlled group-level trial.
BACKGROUND
Quality improvement (QI) programs for depression can improve outcomes of care and reduce outcome disparities; but cumulative effects on mental health outcome disparities have seldom been evaluated.


OBJECTIVE
To estimate cumulative effects over many years of short-term QI programs for depression in primary care on mental health outcome disparities, and to develop an interpretation for annualized, cumulative mental health outcome scores.


METHODS
: We conducted a group-level, randomized controlled trial in 6 US healthcare organizations. The QI programs supported provider and patient education in depression treatment and resources for medication management (QI-Meds) or access to evidence-based psychotherapy (QI-Therapy). Sites were selected to oversample minorities.


METHODS
Results were extrapolated to 1188 initially enrolled and living patients depressed at baseline.


RESULTS
Psychologic well-being (MHI-5) estimated as cumulative outcomes and outcome disparities (minority-whites) over 9 years, and annualized.


RESULTS
Across analyses there was a significant interaction of intervention status and ethnicity [lowest F(2,160) = 4.96, P = 0.008]. QI-therapy improved cumulative outcomes among minorities (mean, 37.92-44.29 MHI-5 points) and reduced outcome disparities for the whole sample relative to usual care (UC) (by mean, 39.44-59.01 MHI-5 points) and relative to QI-Meds (by mean, 53.90-74.41 MHI-5 points), lowest t(103) = 3.12, P = 0.002. By comparison, UC patients who lost a loved one in the year after baseline had lower psychologic well being by 6.18 MHI-5 scale points compared with similar UC patients without such a loss [t(15)=2.52, P = 0.02].


CONCLUSIONS
QI programs incorporating support for evidence-based psychotherapy offer an approach to substantially reduce cumulative outcome disparities for depressed primary care patients.
Wells
Kenneth B
KB
RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA. kwells@ucla.edu
Sherbourne
Cathy D
CD
Miranda
Jeanne
J
Tang
Lingqi
L
Benjamin
Bernadette
B
Duan
Naihua
N
D000328:Adult; D003376:Counseling; D003866:Depressive Disorder / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D006266:Health Education; D006297:Health Services Accessibility / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D008297:Male; D008913:Minority Groups; D011787:Quality of Health Care / Q000639:trends*; D012959:Socioeconomic Factors; D016896:Treatment Outcome