title: Time to Remission for Depression with Collaborative Care Management (CCM) in Primary Care.
abstract: BACKGROUND
  Collaborative care management (CCM) has been shown to have superior outcomes to usual care (UC) for depressed patients with a fixed end point. This study was a survival analysis over time comparing CCM with UC using remission (9-item Patient Health Questionnaire [PHQ-9] score <5) and persistent depressive symptoms (PDSs; PHQ-9 score ≥10) as end points.
  
  
  METHODS
  A retrospective cohort study of 7340 patients with depression cared for at 4 outpatient primary care clinics was conducted from March 2008 through June 2013. All adult patients diagnosed with depression (International Classification of Diseases, 9th Revision [ICD-9], codes 296.2-3) or dysthymia (ICD-9 code 300.4) with an initial PHQ-9 score ≥10 were included. CCM was implemented at all clinics between 2008 and 2010. Kaplan-Meyer survival curves for time to remission and PDSs were plotted. A Cox proportional hazards model was used to adjust for expected differences between patients choosing CCM versus UC.
  
  
  RESULTS
  Median time to remission was 86 days (95% confidence interval [CI], 81-91 days) for the CCM group versus 614 days (95% CI, 565-692 days) for the UC group. Likewise, median duration of PDSs was 31 days (95% CI, 30-33 days) for the CCM group versus 154 days (95% CI, 138-182 days) for the UC group. In the Cox proportional hazards model, which controlled for covariates such as age, sex, race, diagnosis, and initial PHQ-9 score, CCM was associated with faster remission (hazard ratio of the CCM group [HRCCM], 2.48; 95% CI, 2.31-2.65).
  
  
  CONCLUSIONS
  This study demonstrated that patients enrolled in CCM have a faster rate of remission and a shorter duration of PDSs than patients choosing UC.
authors.affiliation: From the Department of Family Medicine (GMG, KBA) and the Department of Psychiatry & Psychology (MDW), Mayo Clinic, Rochester, MN; and the Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY (SSO); Aurora Health Care, Green Bay, WI (TWL). garrison.gregory@mayo.edu.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Garrison
authors.affiliation: From the Department of Family Medicine (GMG, KBA) and the Department of Psychiatry & Psychology (MDW), Mayo Clinic, Rochester, MN; and the Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY (SSO); Aurora Health Care, Green Bay, WI (TWL).
authors.forename: Kurt B
authors.initials: KB
authors.lastname: Angstman
authors.affiliation: From the Department of Family Medicine (GMG, KBA) and the Department of Psychiatry & Psychology (MDW), Mayo Clinic, Rochester, MN; and the Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY (SSO); Aurora Health Care, Green Bay, WI (TWL).
authors.forename: Stephen S
authors.initials: SS
authors.lastname: O'Connor
authors.affiliation: From the Department of Family Medicine (GMG, KBA) and the Department of Psychiatry & Psychology (MDW), Mayo Clinic, Rochester, MN; and the Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY (SSO); Aurora Health Care, Green Bay, WI (TWL).
authors.forename: Mark D
authors.initials: MD
authors.lastname: Williams
authors.affiliation: From the Department of Family Medicine (GMG, KBA) and the Department of Psychiatry & Psychology (MDW), Mayo Clinic, Rochester, MN; and the Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY (SSO); Aurora Health Care, Green Bay, WI (TWL).
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Lineberry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D015331:Cohort Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006302:Health Services Research; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards; D018802:Patient-Centered Care / Q000458:organization & administration* / Q000592:standards; D016016:Proportional Hazards Models; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D000078329:Workforce; D055815:Young Adult
keywords: Depression; Medical Home; Patient-centered Outcomes Research