title: Population targeting and durability of multimorbidity collaborative care management.
abstract: OBJECTIVE
  A patient-centered collaborative care program for depression and uncontrolled diabetes and/or coronary heart disease (CHD) demonstrated improved clinical outcomes relative to usual care. We report clinically stratified analyses of patient outcomes to inform the duration and targeting of care management services for complex patients with multimorbidity.
  
  
  METHODS
  A 12-month randomized controlled trial of a multimorbidity collaborative care program followed patients at 6, 12, 18, and 24 months for diabetes (glycated hemoglobin [A1C]), blood pressure (systolic; SBP), low-density lipoprotein (LDL) cholesterol, and depression (Symptoms Check List-20 score). Depressed patients with less favorable medical control (Patient Health Questionnaire-9 score > 10, A1C > 8.0 %, SBP > 140 mm Hg, and LDL cholesterol > 120 mg/dL) were compared with depressed patients with more favorable medical control to describe differential intervention benefits over time.
  
  
  RESULTS
  In contrast to patients with more favorable baseline control, patients with depression and unfavorable control of A1C, SBP, and LDL at baseline showed improved outcomes as early as the 6-month follow-up assessment. Clinical benefits in the intervention group were largely sustained over the 24-month follow-up, except for some deterioration of glycemic control in intervention patients and trends toward improvement among controls over time. Among patients with depression and more favorable medical control at baseline, there were minimal between-group differences in medical disease outcomes.
  
  
  CONCLUSIONS
  Clinical benefits of a multimorbidity collaborative care management program occurred early, and were only found among patients with poor control of baseline diabetes and CHD risk factors. Targeting may maximize reach and improve affordability of complex care management.
authors.affiliation: 1730 Mi- nor Ave, Ste 1600, Seattle, WA 98101. E-mail: lin.e@ghc.org.
authors.forename: Elizabeth H B
authors.initials: EH
authors.lastname: Lin
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
authors.forename: Do
authors.initials: D
authors.lastname: Peterson
authors.forename: Evette J
authors.initials: EJ
authors.lastname: Ludman
authors.forename: Paul
authors.initials: P
authors.lastname: Ciechanowski
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
mesh_terms: D003327:Coronary Disease / Q000150:complications* / Q000628:therapy; D003863:Depression / Q000150:complications* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000628:therapy; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration / Q000706:statistics & numerical data; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration* / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000379:methods / Q000458:organization & administration* / Q000706:statistics & numerical data; D016896:Treatment Outcome