title: Population level effectiveness of implementing collaborative care management for depression.
abstract: OBJECTIVE
  Care management is feasible to deploy in routine care, and the depression outcomes of patients reached by this evidence-based practice are similar to those observed in randomized controlled trials. However, no studies have estimated the population level effectiveness of care management when deployed in routine care. Population level effectiveness depends on both reach into the target population and the clinical effectiveness for those reached.
  
  
  METHODS
  This multisite hybrid Type 3 effectiveness-implementation study employed a pre-post, quasi-experimental design. The study was conducted at 22 Veterans Affairs community-based outpatient clinics. Evidence-based quality improvement was used as the facilitation strategy to promote adoption. Medication possession ratios (MPRs) were calculated for 1558 patients with an active antidepressant prescription. Differences in treatment response rates at implementation and control sites were estimated from observed differences in MPR.
  
  
  RESULTS
  Reach into the target population at implementation sites was 10.3%. Patients at implementation sites had a significantly higher probability of having MPR≥0.9 than patients at control sites [odds ratio=1.38, confidence interval95=(1.07, 1.78), P=.01]. This increase in MPR was estimated to yield a 1% point increase in response rates.
  
  
  CONCLUSIONS
  While depression care management improves outcomes for patients receiving services, low levels of reach can reduce overall population level effectiveness.
authors.affiliation: Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, AR; South Central Mental Illness Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR. Electronic address: fortneyjohnc@uams.edu.
authors.forename: John C
authors.initials: JC
authors.lastname: Fortney
authors.forename: Mark A
authors.initials: MA
authors.lastname: Enderle
authors.forename: Jeff L
authors.initials: JL
authors.lastname: Clothier
authors.forename: Jay M
authors.initials: JM
authors.lastname: Otero
authors.forename: James S
authors.initials: JS
authors.lastname: Williams
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Pyne
mesh_terms: D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003299:Cooperative Behavior; D003863:Depression / Q000188:drug therapy*; D019468:Disease Management; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
keywords: Collaborative care management; Depression; Implementation