title: Does a quality improvement intervention for anxiety result in differential outcomes for lower-income patients?
abstract: OBJECTIVE
  The authors examined the effects of a collaborative care intervention for anxiety disorders in primary care on lower-income participants relative to those with higher incomes. They hypothesized that lower-income individuals would show less improvement or improve at a lower rate, given that they would experience greater economic stress over the treatment course. An alternative hypothesis was that lower-income participants would improve at a higher rate because the intervention facilitates access to evidence-based treatment, which typically is less available to persons with lower incomes.
  
  
  METHODS
  Baseline demographic and clinical characteristics of patients with lower (N=287) and higher (N=717) income were compared using t tests and chi-square tests for continuous and categorical variables, respectively. For the longitudinal analysis of intervention effects by income group, the outcome measures were jointly modeled at baseline and at 6, 12, and 18 months by study site, income, time, intervention, time and intervention, income and time, income and intervention, and time, intervention, and income.
  
  
  RESULTS
  Although lower-income participants were more ill and had greater disability at baseline than those with higher incomes, the two income groups were similar in clinical response. The lower-income participants experienced a comparable degree of clinical improvement, despite receiving fewer treatment sessions, less relapse prevention, and less continuous care.
  
  
  CONCLUSIONS
  These findings contribute to the ongoing discussion as to whether or not, and to what extent, quality improvement interventions work equally well across income groups or require tailoring for specific vulnerable populations.
authors: Department of Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, North Little Rock, AR, USA. gsullivan@uams.edu
authors: Greer
authors: G
authors: Sullivan
authors: Cathy
authors: C
authors: Sherbourne
authors: Denise A
authors: DA
authors: Chavira
authors: Michelle G
authors: MG
authors: Craske
authors: Daniela
authors: D
authors: Gollineli
authors: Xiaotong
authors: X
authors: Han
authors: Raphael D
authors: RD
authors: Rose
authors: Alexander
authors: A
authors: Bystritsky
authors: Murray B
authors: MB
authors: Stein
authors: Peter
authors: P
authors: Roy-Byrne
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000191:economics / Q000208:ethnology / Q000628:therapy; D016009:Chi-Square Distribution; D017281:Cost of Illness; D055317:Evidence-Based Practice / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010346:Patient Care Management / Q000458:organization & administration; D011203:Poverty / Q000523:psychology*; D011320:Primary Health Care / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D058996:Quality Improvement; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
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