title: Collaborative Depression Care in a Safety Net Medical Home: Facilitators and Barriers to Quality Improvement.
abstract: Little is known about how to integrate primary care with mental/behavioral services outside of clinical trials. The authors implemented a collaborative care model (CCM) for depression in a safety net patient-centered medical home. The model focused on universal screening for symptoms, risk stratification based on symptom severity, care management for intensive follow-up, and psychiatry consultation. CCM increased rates of primary care physician encounters, timely follow-up for monitoring symptoms of depression, and documentation of treatment response. Contextual factors that facilitated or hindered practice redesign included clinic leadership, quality improvement culture, staffing, technology infrastructure, and external incentives/disincentives for organizational change.
authors.affiliation: 1 Ochsner Health System , Departments of Internal Medicine and Research, New Orleans, Louisiana.|2 Tulane University School of Medicine , Department of Medicine, New Orleans, Louisiana.
authors.forename: Eboni G
authors.initials: EG
authors.lastname: Price-Haywood
authors.affiliation: 2 Tulane University School of Medicine , Department of Medicine, New Orleans, Louisiana.
authors.forename: Donisha
authors.initials: D
authors.lastname: Dunn-Lombard
authors.affiliation: 1 Ochsner Health System , Departments of Internal Medicine and Research, New Orleans, Louisiana.
authors.forename: Jewel
authors.initials: J
authors.lastname: Harden-Barrios
authors.affiliation: 3 Tulane University School of Public Health and Tropical Medicine , Department of Biostatistics and Bioinformatics, New Orleans, Louisiana.
authors.forename: John J
authors.initials: JJ
authors.lastname: Lefante
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D003863:Depression / Q000188:drug therapy*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D055820:New Orleans; D018802:Patient-Centered Care / Q000592:standards*; D011203:Poverty; D058996:Quality Improvement; D012189:Retrospective Studies