Using evidence-based quality improvement methods for translating depression collaborative care research into practice.
OBJECTIVE
Translating Initiatives in Depression into Effective Solution (TIDES) aimed to translate research-based collaborative care for depression into an approach for the Veterans Health Administration (VA). SITES: Three multistate administrative regions and seven of their medium-sized primary care practices.


METHODS
Researchers assisted regional leaders in adapting research-based depression care models using evidence-based quality improvement (EBQI) methods.


RESULTS
We evaluated model fidelity and impacts on patients. Trained nurse depression care managers collected data on patient adherence and outcomes.


RESULTS
Among 72% (128) of the 178 patients followed in primary care with depression care manager assistance during the 3-year study period, mean PHQ-9 scores dropped from 15.1 to 4.7 (p < .001). A total of 87% of patients achieved a PHQ-9 score lower than 10 (no major depression). 62% achieved a score lower than six (symptom resolution). Care managers referred 28% (50) TIDES patients to mental health specialty (MHS). In the MHS-referred group, mean PHQ-9 scores dropped from 16.4 to 9.0 (p < .001). A total of 58% of MHS-referred patients achieved a PHQ-9 score lower than 10, and 40%, a score less than 6. Over the 2 years following the initial development phase reported here, national policymakers endorsed TIDES through national directives and financial support.


CONCLUSIONS
TIDES developed an evidence-based depression collaborative care prototype for a large health care organization (VA) using EBQI methods. As expected, care managers referred sicker patients to mental health specialists; these patients also improved. Overall, TIDES achieved excellent overall patient outcomes, and the program is undergoing national spread.
Rubenstein
Lisa V
LV
Department of Medicine and Health Services Research, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. lisa.rubenstein@va.gov
Chaney
Edmund F
EF
Ober
Scott
S
Felker
Bradford
B
Sherman
Scott E
SE
Lanto
Andy
A
Vivell
Susan
S
D003299:Cooperative Behavior; D003865:Major Depressive Disorder / Q000628:therapy*; D055317:Evidence-Based Practice; D006801:Humans; D007256:Information Systems; D007318:Inservice Training / Q000458:organization & administration; D008605:Mental Health Services / Q000458:organization & administration*; D010346:Patient Care Management / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D057170:Translational Research, Biomedical / Q000458:organization & administration; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration