title: Impact of a national collaborative care initiative for patients with depression and diabetes or cardiovascular disease.
abstract: The spread of evidence-based care is an important challenge in healthcare. We evaluated spread of an evidence-based large-scale multisite collaborative care model for patients with depression and diabetes and/or cardiovascular disease (COMPASS).
  
  
  
  Primary care patients with depression and comorbid diabetes or cardiovascular disease were recruited. Collaborative care teams used care management tracking systems and systematic case reviews to track and intensify treatment for patients not improving. Targeted outcomes were depression remission and response (assessed with the Patient Health Questionnaire-9) and control of diabetes (assessed by HbA1c) and blood pressure. Patients and clinicians were surveyed about satisfaction with care.
  
  
  
  Eighteen care systems and 172 clinics enrolled 3609 patients across the US. Of those with uncontrolled disease at enrollment, 40% achieved depression remission or response, 23% glucose control and 58% blood pressure control during a mean follow-up of 11 months. There were large variations in outcomes across medical groups. Patients and clinicians were satisfied with COMPASS care.
  
  
  
  COMPASS was successfully spread across diverse care systems and demonstrated improved outcomes for complex patients with previously uncontrolled chronic disease. Future large-scale implementation projects should create robust processes to identify and reduce expected variation in implementation to consistently provide improved care.
authors: HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425. Electronic address: Rebecca.C.Rossom@HealthPartners.com.
authors: Rebecca C
authors: RC
authors: Rossom
authors: HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425.
authors: Leif I
authors: LI
authors: Solberg
authors: Institute for Clinical Systems Improvement, 8009 34th Ave. S., Suite 1200, Bloomington, MN, 55425-1624.
authors: Sanne
authors: S
authors: Magnan
authors: HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425.
authors: A Lauren
authors: AL
authors: Crain
authors: Kaiser Permanente Colorado Institute for Health Research, P.O. Box 378066, Denver, CO, 80237-8066.
authors: Arne
authors: A
authors: Beck
authors: Kaiser Permanente Southern California, Department of Research and Evaluation, 100 S. Los Robles Ave., 2nd Floor, Pasadena, CA, 91101-2453.
authors: Karen J
authors: KJ
authors: Coleman
authors: Mayo Clinic, Psychiatry and Psychology Division of Integrated Behavioral Health, 200 First St. SW, Rochester, MN, 55905.
authors: David
authors: D
authors: Katzelnick
authors: Mayo Clinic, Psychiatry and Psychology Division of Integrated Behavioral Health, 200 First St. SW, Rochester, MN, 55905.
authors: Mark D
authors: MD
authors: Williams
authors: Institute for Clinical Systems Improvement, 8009 34th Ave. S., Suite 1200, Bloomington, MN, 55425-1624.
authors: Claire
authors: C
authors: Neely
authors: HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425.
authors: Kris
authors: K
authors: Ohnsorg
authors: HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425; University of St. Thomas, School of Social Work, 2115 Summit Ave, St. Paul, MN, 55105.
authors: Robin
authors: R
authors: Whitebird
authors: Community Health Plan of Washington, 720 Olive Way, Suite 300, Seattle, WA, 98101-1830.
authors: Emily
authors: E
authors: Brandenfels
authors: Mount Auburn Cambridge Independent Practice Association, 1380 Soldiers Field Rd., Floor 2, Brighton, MA, 02135-1023.
authors: Betsy
authors: B
authors: Pollock
authors: Pittsburgh Regional Health Initiative, 650 Smithfield St., Centre City Tower, Suite 2400, Pittsburgh, PA, 15222-3900.
authors: Robert
authors: R
authors: Ferguson
authors: Michigan Center for Clinical Systems Improvement, 233 E. Fulton St., Suite 20, Grand Rapids, MI, 49503-3261.
authors: Steve
authors: S
authors: Williams
authors: University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195-6560.
authors: Jürgen
authors: J
authors: Unützer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000628:therapy*; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D000070516:Intersectoral Collaboration; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Collaborative care; Depression; Diabetes; Heart disease; Primary care