title: Improving care for depression: performance measures, outcomes and insights from the Health Disparities Collaboratives.
abstract: This paper reports 10 measures, outcomes, and insights from HRSA Depression Health Disparities Collaboratives, representing attempts to accelerate evidence-based guidelines into practice. The authors analyze interviews with leadership of high-performing centers. Monthly data was submitted on 38,000 patients from 94 centers. Regression analyses were conducted to identify process measures predictive of better outcomes. Results indicated that these 10 measures of care were effective in guiding and quantifying improved outcomes. One measure, early and sustained response (ESR), proved particularly useful as it reflects long term outcomes. Regression analyses identified one process measure (Patient Health Questionnaire Reassessment) strongly associated with improved clinical outcomes (n=37, R2=44%). Interviews identified 18 process changes deemed pivotal for meaningful change. In sum, well-designed approaches utilizing proven improvement methodologies resulted in substantial enhancements in depression care. This approach and these measures, especially ESR and PHQ Reassessment, may improve depression care in other under-served settings.
authors.affiliation: Stony Brook Medical Center and Depression Health Disparities Collaborative, USA. stevecolemd@gmail.com
authors.forename: Steven
authors.initials: S
authors.lastname: Cole
authors.forename: Kathy
authors.initials: K
authors.lastname: Reims
authors.forename: Liz
authors.initials: L
authors.lastname: Kershner
authors.forename: Harriet G
authors.initials: HG
authors.lastname: McCombs
authors.forename: Kevin
authors.initials: K
authors.lastname: Little
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Ford
mesh_terms: D003299:Cooperative Behavior; D003863:Depression / Q000628:therapy*; D019317:Evidence-Based Medicine; D006302:Health Services Research; D054625:Healthcare Disparities; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D016896:Treatment Outcome; D014481:United States; D014488:United States Health Resources and Services Administration / Q000458:organization & administration*