title: Collaborative depression care among Latino patients in diabetes disease management, Los Angeles, 2011-2013.
abstract: BACKGROUND
  The prevalence of comorbid diabetes and depression is high, especially in low-income Hispanic or Latino patients. The complex mix of factors in safety-net care systems impedes the adoption of evidence-based collaborative depression care and results in persistent disparities in depression outcomes. The Diabetes-Depression Care-Management Adoption Trial examined whether the collaborative depression care model is an effective approach in safety-net clinics to improve clinical care outcomes of depression and diabetes.
  
  
  METHODS
  A sample of 964 patients with diabetes from 5 safety-net clinics were enrolled in a quasi-experimental study that included 2 arms: usual care, in which primary medical providers and staff translated and adopted evidence-based depression care; and supportive care, in which providers of a disease management program delivered protocol-driven depression care. Because the study design established individual treatment centers as separate arms, we calculated propensity scores that interpreted the probability of treatment assignment conditional on observed baseline characteristics. Primary outcomes were 5 depression care outcomes and 7 diabetes care measures. Regression models with propensity score covariate adjustment were applied to analyze 6-month outcomes.
  
  
  RESULTS
  Compared with usual care, supportive care significantly decreased Patient Health Questionnaire-9 scores, reduced the number of patients with moderate or severe depression, improved depression remission, increased satisfaction in care for patients with emotional problems, and significantly reduced functional impairment.
  
  
  CONCLUSIONS
  Implementing collaborative depression care in a diabetes disease management program is a scalable approach to improve depression outcomes and patient care satisfaction among patients with diabetes in a safety-net care system.
authors.affiliation: School of Social Work and Epstein Department of Industrial and Systems Engineering, University of Southern California, 669 W 34th St, Montgomery Ross Fisher Bldg, Los Angeles, CA 90089-0411. E-mail: shinyiwu@usc.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: Wu
authors.affiliation: University of Southern California, Los Angeles, California.
authors.forename: Haomiao
authors.initials: H
authors.lastname: Jin
authors.forename: Irene
authors.initials: I
authors.lastname: Vidyanti
authors.affiliation: University of Southern California, Los Angeles, California.
authors.forename: Pey-Jiuan
authors.initials: PJ
authors.lastname: Lee
authors.affiliation: University of Southern California, Los Angeles, California.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ell
authors.affiliation: RAND Corporation, Santa Monica, California.
authors.forename: Shinyi
authors.initials: S
authors.lastname: Wu
mesh_terms: D015897:Comorbidity; D057186:Comparative Effectiveness Research; D019033:Delivery of Health Care, Integrated; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D055317:Evidence-Based Practice; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007843:Latin America / Q000208:ethnology; D016014:Linear Models; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management; D010348:Patient Care Team; D012042:Registries; D064876:Safety-net Providers; D057170:Translational Research, Biomedical; D016896:Treatment Outcome