Findings

Implementation and Maintenance of Quality Improvement for Treating Depression in Primary Care
Meredith LS, Mendel P, Pearson M et al., Psychiatric Services, 57 48-55, 2006.

Objective: To describe the changes made and examine factors associated with the success of implementation, maintenance, and spread of practice-based quality improvement (QI) efforts to put promising new primary care practice models for depression into place locally.

Study Design: Cross-sectional analysis of qualitative data coded from monthly progress reports completed throughout QI implementation and telephone interviews conducted with key team leaders 18 months following implementation. Implementation success was evaluated using measures of change activities, changes that teams rated a success, maintenance of changes, and spread of changes. Other variables evaluated were reported barriers and facilitators to change, and organization and community characteristics.

Population Studied: We evaluated the QI process of 17 multi-disciplinary QI teams (11 public community health centers and 6 private health care practices) participating in the Improving Chronic Illness Care and Institute for Healthcare Improvement’s Breakthrough Series for depression in 2001.

Principle Findings: Implementation of change activities was varied with some changes made by only 1 or 2 organizations (planned visits, community linkages) while other changes were made by all (proactive follow-up, patient education, patient registry, and patient management information systems). Organizations most commonly reported success for changes to delivery and information system changes (59% and 53%) and more sites sustained these changes over time (59% and 94%). Organizational structure and leadership support were the most common facilitators while staff resistance, time, and information technology were the most common barriers. Different strategies for success varied with different sets of barriers.

Conclusions: Despite the challenges associated with QI for depression, we observed broad success across 17 different multi-disciplinary teams.

Implications for Policy, Delivery, or Practice: Detailed findings about QI implementation such as these should be helpful in guiding future efforts to improve chronic illness care.

Presented at the AcademyHealth meeting by: Lisa S. Meredith, RAND, at the Chronic Care Poster Session B, 7:30 - 8:45 am, June 8.