title: Complexity in Redesigning Depression Care: Comparing Intention Versus Implementation of an Automated Depression Screening and Monitoring Program.
abstract: Health care technology promises to improve quality and decrease costs while improving the patient experience. A recent trial tested a novel health technology that sought to reduce barriers to guideline-recommended depression care by coupling automated telephonic patient assessment with provider notification and decision support. This study compares the intended effects and the end users' experience with using this technology. Responses to semi-structured interviews with the leadership and design team (the intention group) were compared with responses from health professionals in clinics using the technology (the implementation group). Qualitative methods were applied to compare perspectives on the role of technology in care delivery and on the technology's impact on barriers to providing guideline-recommended care. Four members of the intention group and 17 members of the implementation group were interviewed. The 2 groups had similar notions of technology's role in care delivery. The technology increased provider awareness, empowered midlevel providers, and facilitated collaboration among care team members. However, the implementation group identified gaps in care processes and in the informatics system that the technology did not address, and for which providers remained responsible. The 2 groups had comparable perspectives on the value and limits of technology in improving adherence to guideline-recommended care. However, the intention group did not discuss many of the shortcomings identified by the implementation group. Also, the interviews suggest that although some barriers persisted and a few new ones arose, the technology succeeded in reducing barriers to guideline-recommended care.
authors.affiliation: 1 Baptist Health Medical Group , Coral Gables, Florida.|2 Department of Family Medicine, Herbert Wertheim College of Medicine at Florida International University , Miami, Florida.|3 Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at UCLA , Los Angeles, California.
authors.forename: Paul
authors.initials: P
authors.lastname: Di Capua
authors.affiliation: 4 Keck School of Medicine, University of Southern California , Los Angeles, California.
authors.forename: Brian
authors.initials: B
authors.lastname: Wu
authors.affiliation: 5 UCLA Fielding School of Public Health , Los Angeles, California.
authors.forename: Renee
authors.initials: R
authors.lastname: Sednew
authors.affiliation: 6 Pardee RAND Graduate School, RAND Corporation , Santa Monica, California.
authors.forename: Gery
authors.initials: G
authors.lastname: Ryan
authors.affiliation: 7 School of Social Work and Epstein Department of Industrial and Systems Engineering, University of Southern California , RAND Corporation, Los Angeles, California.
authors.forename: Shinyi
authors.initials: S
authors.lastname: Wu
mesh_terms: D001331:Automation; D003661:Decision Support Techniques; D003863:Depression / Q000175:diagnosis* / Q000628:therapy; D004059:Diffusion of Innovation; D019983:Guideline Adherence; D006801:Humans; D033182:Intention; D007407:Interviews as Topic; D036301:Qualitative Research; D011787:Quality of Health Care; D013689:Telephone