title: Assessing organizational readiness for depression care quality improvement: relative commitment and implementation capability.
abstract: BACKGROUND
  Depression is a major cause of morbidity and cost in primary care patient populations. Successful depression improvement models, however, are complex. Based on organizational readiness theory, a practice's commitment to change and its capability to carry out the change are both important predictors of initiating improvement. We empirically explored the links between relative commitment (i.e., the intention to move forward within the following year) and implementation capability.
  
  
  METHODS
  The DIAMOND initiative administered organizational surveys to medical and quality improvement leaders from each of 83 primary care practices in Minnesota. Surveys preceded initiation of activities directed at implementation of a collaborative care model for improving depression care. To assess implementation capability, we developed composites of survey items for five types of organizational factors postulated to be collaborative care barriers and facilitators. To assess relative commitment for each practice, we averaged leader ratings on an identical survey question assessing practice priorities. We used multivariable regression analyses to assess the extent to which implementation capability predicted relative commitment. We explored whether relative commitment or implementation capability measures were associated with earlier initiation of DIAMOND improvements.
  
  
  RESULTS
  All five implementation capability measures independently predicted practice leaders' relative commitment to improving depression care in the following year. These included the following: quality improvement culture and attitudes (p = 0.003), depression culture and attitudes (p <0.001), prior depression quality improvement activities (p <0.001), advanced access and tracking capabilities (p = 0.03), and depression collaborative care features in place (p = 0.03). Higher relative commitment (p = 0.002) and prior depression quality improvement activities appeared to be associated with earlier participation in the DIAMOND initiative.
  
  
  CONCLUSIONS
  The study supports the concept of organizational readiness to improve quality of care and the use of practice leader surveys to assess it. Practice leaders' relative commitment to depression care improvement may be a useful measure of the likelihood that a practice is ready to initiate evidence-based depression care changes. A comprehensive organizational assessment of implementation capability for depression care improvement may identify specific barriers or facilitators to readiness that require targeted attention from implementers.
authors.affiliation: RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA. lisar@rand.org.|Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA, 91343, USA. lisar@rand.org.
authors.forename: Lisa V
authors.initials: LV
authors.lastname: Rubenstein
authors.affiliation: RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA. mjsdanz@gmail.com.|Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA, 91343, USA. mjsdanz@gmail.com.
authors.forename: Marjorie S
authors.initials: MS
authors.lastname: Danz
authors.affiliation: HealthPartners Research Foundation, Minneapolis, MN, 55440, USA. Lauren.A.Crain@HealthPartners.com.
authors.forename: A Lauren
authors.initials: AL
authors.lastname: Crain
authors.affiliation: Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, 20852, USA. russell.glasgow@ucdenver.edu.
authors.forename: Russell E
authors.initials: RE
authors.lastname: Glasgow
authors.affiliation: HealthPartners Research Foundation, Minneapolis, MN, 55440, USA. Robin.R.Whitebird@HealthPartners.com.
authors.forename: Robin R
authors.initials: RR
authors.lastname: Whitebird
authors.affiliation: HealthPartners Research Foundation, Minneapolis, MN, 55440, USA. Leif.I.Solberg@HealthPartners.com.
authors.forename: Leif I
authors.initials: LI
authors.lastname: Solberg
mesh_terms: D000328:Adult; D003156:Community Mental Health Services / Q000592:standards; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000628:therapy*; D006284:Health Plan Implementation / Q000458:organization & administration; D006801:Humans; D008910:Minnesota; D009936:Organizational Innovation; D011320:Primary Health Care / Q000592:standards; D058996:Quality Improvement