Impact of a national collaborative care initiative for patients with depression and diabetes or cardiovascular disease
Impact of a national collaborative care initiative for patients with depression and diabetes or cardiovascular disease
复制标题
DOI：
10.1016/j.genhosppsych.2016.05.006
复制
发表时间：
2017-01-01
影响因子：
7
通讯作者：
Unutzer, Jurgen
中科院分区：
文献类型：
--
作者：
Rossom, Rebecca C.;Solberg, Leif I.;Unutzer, Jurgen
目的：循证护理的推广是医疗保健领域的一个重要挑战。我们评估了一个以证据为基础的大规模多站点协作护理模式的抑郁症和糖尿病和/或心血管疾病患者（COMPASS）的传播。方法：招募了抑郁症和共病糖尿病或心血管疾病的初级保健患者。协作护理团队使用护理管理跟踪系统和系统性病例回顾来跟踪和加强对未改善患者的治疗。目标结局为抑郁缓解和反应（使用患者健康问卷-9评估）以及糖尿病控制（通过HbA1c评估）和血压。患者和临床医生进行了调查的满意度与care.Results：18个护理系统和172个诊所在美国招募了3609名患者。在入组时疾病未得到控制的患者中，40%的患者在平均11个月的随访期间实现了抑郁缓解或反应，23%的血糖控制和58%的血压控制。医疗组之间的结果差异很大。患者和临床医生都很满意COMPASS care.Conclusions：COMPASS成功地传播到不同的护理系统，并证明了改善复杂的患者与以前不受控制的慢性疾病的结果。未来的大规模实施项目应创建强大的流程，以识别和减少实施中的预期变化，从而始终如一地提供更好的护理。(C)2016 Elsevier Inc. All rights reserved.
Objective: 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).Methods: 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.Results: 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.Conclusions: 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. (C) 2016 Elsevier Inc. All rights reserved.