Inducing sustainable improvement in depression care in primary care practices.
BACKGROUND
Improving primary care depression care is costly and challenging to sustain. The feasibility and potential success ofa modified improvement collaborative model to create sustained improvements in depression care was assessed.


METHODS
Sixteen practices from the American Academy of Family Physicians National Research Network and the American College of Physicians Practice-based Research Network completed a nine-month program. Two practice champions (PCs) from each practice attended three two-day learning sessions, where practice change strategies and key depression care elements were discussed. The nine-item Patient Health Questionnaire (PHQ-9) was used for screening, diagnosis, surveillance, tracking and care management, and self-management support. Pre- and postintervention depression care survey data were gathered from all practice clinicians, and qualitative data were collected via interviews with PCs and field notes from learning sessions.


RESULTS
On the basis of PC reports at nine months, 16 practices had implemented the PHQ-9 for depression case-finding and 13 for monitoring severity; 5 practices had implemented tracking and care management and 1, self-management support. At the 15-month follow-up, nearly all changes had been sustained, and additional practices had implemented tracking/care management and self-management support. Significant pre-post improvements were reported on several subscales of the clinician survey, demonstrating substantial diffusion from the PC to other clinicians in the practice.


CONCLUSIONS
The program led to measurable improvements in implementation of office procedures and systems known to improve depression care. The improvements were both sustained beyond the end of the program and substantially diffused to the other clinicians in the practice.
Nease
Donald E
DE
Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA. dnease@umich.edu
Nutting
Paul A
PA
Dickinson
W Perry
WP
Bonham
Aaron J
AJ
Graham
Deborah G
DG
Gallagher
Kaia M
KM
Main
Deborah S
DS
D003866:Depressive Disorder / Q000175:diagnosis* / Q000628:therapy*; D019983:Guideline Adherence / Q000458:organization & administration; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007256:Information Systems / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration*; D012648:Self Care; D011795:Surveys and Questionnaires