| Sustainability of depression care improvements: success of a practice change improvement collaborative. | |
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MedLine Citation:
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PMID: 20823354 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Long-term sustainment of improvements in care continues to challenge primary care practices. During the 2 years after of our Improving Depression Care collaborative, we examined how well practices were sustaining their depression care improvements. METHODS: Our study design used a qualitative interview follow-up of a modified learning collaborative intervention. We conducted telephone interviews with practice champions from 15 of the original 16 practices. Interviews were conducted during a 3-month period in 2008, and were recorded and professionally transcribed. Data on each of the depression care improvements and the change management strategy emphasized during the learning collaborative were summarized after review of the primary data and a consensus process to resolve differing interpretations. RESULTS: During the period from 15 months to 3 years since our project began, depression screening or case finding was sustained in 14 of 15 practices. Thirteen practices sustained use of the 9-item Patient Health Questionnaire for depression monitoring, and one additional practice initiated it. Seven practices initiated self-management support and 2 of 3 practices sustained it. In contrast, tracking and case management proved difficult to sustain, with only 4 of 8 practices continuing this activity. Diffusion of use of the 9-item Patient Health Questionnaire to other clinicians in the practice was maintained in all but 3 practices and expanded in one practice. Six of the practices continued to use the change management strategy, including all 4 of the practices that sustained tracking. CONCLUSIONS: Practices demonstrated long-term sustained improvement in depression care with the exception of tracking and care management, which may be a more challenging innovation to sustain. We hypothesize that sustaining complex depression care innovations may require active management by the practice. |
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Authors:
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Donald E Nease; Paul A Nutting; Deborah G Graham; W Perry Dickinson; Kaia M Gallagher; Michelle Jeffcott-Pera |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of the American Board of Family Medicine : JABFM Volume: 23 ISSN: 1557-2625 ISO Abbreviation: J Am Board Fam Med Publication Date: 2010 Sep-Oct |
Date Detail:
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Created Date: 2010-09-08 Completed Date: 2011-01-19 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101256526 Medline TA: J Am Board Fam Med Country: United States |
Other Details:
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Languages: eng Pagination: 598-605 Citation Subset: IM |
Affiliation:
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Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA. dnease@umich.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Case Management Depressive Disorder / diagnosis*, therapy* Follow-Up Studies Guideline Adherence Humans Mass Screening / methods Primary Health Care / methods*, standards Qualitative Research Quality Assurance, Health Care / methods |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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