Policy makers do not know how to alter the structure and process of primary care to provide treatment which will improve and sustain improvement in the functional impairment associated with major depression, the fourth leading cause of disability worldwide. To address this problem, we propose the Quality Improvement for Depression (QID).
The specific aims of QID are: (1) to provide integrated analyses of the long term impact of four distinct but related primary care interventions to improve depression treatment during the acute, continuation, and maintenance phase of care; and (2) to estimate the effects of high quality primary care depression treatment on long term disability. In the early stages of QID collaboration, funded investigators of four separately conceived quality improvement interventions planned and implemented a coordinated strategy for recruitment, intervention, and data collection in 108 primary care clinics in network and staff model HMOs, IPAs, PPOs, and mixed model settings. In addition to common baseline organizational and provider data, QID investigators are collecting over 80 common variables from 1,980 patients with major depression at each of three waves across the first year. This application seeks support to conduct effectiveness analyses in the combined database after standardizing patient follow-up during the second year across the four projects. This effort is needed to understand the """"""""big picture"""""""" of how four dissemination interventions which are feasible to integrate across a variety of practice settings and populations, impact the quality and outcome of care, with sufficient power to determine whether they improve outcomes over a duration meaningful to policy makers. The analyses will inform policy debates about effective mental health treatment by providing generalizable estimates of the effect of antidepressant medication and psychotherapy on disability over the long term.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH057992-02
Application #
2891062
Study Section
Special Emphasis Panel (ZMH1-CRB-W (01))
Program Officer
Goldstein, Harold
Project Start
1998-09-01
Project End
2003-04-30
Budget Start
1999-05-01
Budget End
2000-04-30
Support Year
2
Fiscal Year
1999
Total Cost
Indirect Cost
Name
Rand Corporation
Department
Type
DUNS #
City
Santa Monica
State
CA
Country
United States
Zip Code
90401
Wells, Kenneth B; Schoenbaum, Michael; Duan, Naihua et al. (2007) Cost-effectiveness of quality improvement programs for patients with subthreshold depression or depressive disorder. Psychiatr Serv 58:1269-78
Clever, Sarah L; Ford, Daniel E; Rubenstein, Lisa V et al. (2006) Primary care patients' involvement in decision-making is associated with improvement in depression. Med Care 44:398-405
Miranda, Jeanne; Schoenbaum, Michael; Sherbourne, Cathy et al. (2004) Effects of primary care depression treatment on minority patients' clinical status and employment. Arch Gen Psychiatry 61:827-34
Schoenbaum, Michael; Miranda, Jeanne; Sherbourne, Cathy et al. (2004) Cost-effectiveness of interventions for depressed Latinos. J Ment Health Policy Econ 7:69-76
Wells, Kenneth; Sherbourne, Cathy; Schoenbaum, Michael et al. (2004) Five-year impact of quality improvement for depression: results of a group-level randomized controlled trial. Arch Gen Psychiatry 61:378-86
Schoenbaum, M; Unutzer, J; Sherbourne, C et al. (2001) Cost-effectiveness of practice-initiated quality improvement for depression: results of a randomized controlled trial. JAMA 286:1325-30