title: Implementation of collaborative depression management at community-based primary care clinics: an evaluation.
abstract: OBJECTIVE
  This study evaluated a large demonstration project of collaborative care of depression at community health centers by examining the role of clinic site on two measures of quality care (early follow-up and appropriate pharmacotherapy) and on improvement of symptoms (score on Patient Health Questionnaire-9 reduced by 50% or ≤ 5).
  
  
  METHODS
  A quasi-experimental study examined data on the treatment of 2,821 patients aged 18 and older with depression symptoms between 2006 and 2009 at six community health organizations selected in a competitive process to implement a model of collaborative care. The model's key elements were use of a Web-based disease registry to track patients, care management to support primary care providers and offer proactive follow-up of patients, and organized psychiatric consultation.
  
  
  RESULTS
  Across all sites, a plurality of patients achieved meaningful improvement in depression, and in many sites, improvement occurred rapidly. After adjustment for patient characteristics, multivariate logistic regression models revealed significant differences across clinics in the probability of receiving early follow-up (range .34-.88) or appropriate pharmacotherapy (range .27-.69) and in experiencing improvement (.36 to .84). Similarly, after adjustment for patient characteristics, Cox proportional hazards models revealed that time elapsed between first evaluation and the occurrence of improvement differed significantly across clinics (p<.001).
  
  
  CONCLUSIONS
  Despite receiving similar training and resources, organizations exhibited substantial variability in enacting change in clinical care systems, as evidenced by both quality indicators and outcomes. Sites that performed better on quality indicators had better outcomes, and the differences were not attributable to patients' characteristics.
authors: Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St, Box 356560, Seattle, WA 98195, USA. abauer1@u.washington.edu
authors: Amy M
authors: AM
authors: Bauer
authors: Vanessa
authors: V
authors: Azzone
authors: Howard H
authors: HH
authors: Goldman
authors: Laurie
authors: L
authors: Alexander
authors: Jürgen
authors: J
authors: Unützer
authors: Brenda
authors: B
authors: Coleman-Beattie
authors: Richard G
authors: RG
authors: Frank
mesh_terms: D000328:Adult; D003153:Community Health Services; D003299:Cooperative Behavior; D003863:Depression / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D016730:Program Development; D012042:Registries; D011795:Surveys and Questionnaires