title: Improving depression care in a psychiatry resident psychopharmacology clinic: measurement, monitoring, feedback and education.
abstract: OBJECTIVE
  Better outcomes for major depressive disorder (MDD) are associated with proactive treatment, including timely follow-up, systematic assessment and treatment changes for inadequate improvement. The effectiveness of an intervention to facilitate proactive treatment for MDD in a resident psychopharmacology clinic was studied.
  
  
  METHODS
  A quality improvement program with administrative process changes to improve flow and a 40-week pre/post study to evaluate the effect of education and feedback was conducted. A systematic assessment and reengineered scheduling system were implemented. During the first 20 weeks, baseline data were collected; during the second 20 weeks, feedback to residents and attending psychiatrists about adherence to evidence-based treatment recommendations was added.
  
  
  RESULTS
  Reengineering our system to improve flow was successful. By linking outcomes collection to completion of billing sheets, outcomes at 90% of visits for MDD throughout the 40-week study was assessed. By centralising our scheduling system, the percentage of active-phase patients with MDD seen for follow-up within 6 weeks was improved from 19% to 59%. In response to feedback, residents did not make significant changes to their overall practice patterns. Patient outcomes did not improve as a result of feedback to residents. Residents did improve their practice patterns for a subset of patients including those without comorbid psychiatric disorders and those whose depressive episodes had lasted <1 year.
  
  
  CONCLUSIONS
  Improving administrative processes for the treatment of patients with MDD resulted in rapid changes that were associated with improvements in the delivery of evidence-based care. Feedback to residents was more difficult and less successful.
authors.affiliation: Department of Psychiatry, Dartmouth Medical School, Lebanon, New Hampshire, USA. brian.r.shiner@dartmouth.edu
authors.forename: Brian
authors.initials: B
authors.lastname: Shiner
authors.forename: R L
authors.initials: RL
authors.lastname: Green
authors.forename: K
authors.initials: K
authors.lastname: Homa
authors.forename: B V
authors.initials: BV
authors.lastname: Watts
authors.forename: A
authors.initials: A
authors.lastname: Groft
authors.forename: W C
authors.initials: WC
authors.lastname: Torrey
authors.forename: T E
authors.initials: TE
authors.lastname: Oxman
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration / Q000592:standards*; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001071:Appointments and Schedules; D003865:Major Depressive Disorder / Q000188:drug therapy*; D019983:Guideline Adherence; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration / Q000592:standards*; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D017064:Process Assessment, Health Care; D011570:Psychiatry / Q000458:organization & administration / Q000592:standards*; D012074:Remission Induction; D013997:Time Factors
chemical_list: D000928:Antidepressive Agents