Impact of disseminating quality improvement programs for depression in managed primary care -: A randomized controlled trial
Impact of disseminating quality improvement programs for depression in managed primary care -: A randomized controlled trial
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DOI：
10.1001/jama.283.2.212
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发表时间：
2000-01-12
影响因子：
120.7
通讯作者：
Rubenstein, LV
中科院分区：
文献类型：
--
作者：
Wells, KB;Sherbourne, C;Rubenstein, LV
背景在管理式初级保健环境中对抑郁症患者的护理通常达不到指南标准，但在这种环境中抑郁症护理的质量改进(QI)计划的长期影响尚不清楚。目的确定管理式初级保健实践中的QI计划是否改善了抑郁症初级保健患者的护理质量、健康结果和就业。设计从1996年6月至1997年3月开始的随机对照试验。在6个美国管理型保健组织中设置46个初级保健诊所。参与者27 332名连续筛查患者，1356名目前有抑郁症状的患者，或未登记抑郁症。配对的诊所被随机分配到常规护理(邮寄实践指南)或2个QI计划中的1个，这些QI计划涉及机构对QI的承诺，培训当地专家和护士提供临床医生和患者教育，识别潜在的抑郁症患者池，以及护士进行药物随访或接触训练有素的心理治疗师。主要结果衡量护理过程(抗抑郁药物的使用、心理健康专科咨询访问、精神健康问题的医疗访问、任何医疗访问)、健康结果(可能的抑郁症和与健康相关的生活质量[HRQOL])，结果QI(n=913)和对照(n=443)诊所的患者在基线服务使用、HRQOL或无反应加权后的就业方面没有显著差异。6个月时，50.9%的QI患者和39.7%的对照组接受了咨询或使用了适当剂量的抗抑郁药物(P
Context Care of patients with depression in managed primary care settings often fails to meet guideline standards, but the long-term impact of quality improvement (QI) programs for depression care in such settings is unknown.Objective To determine if QI programs in managed care practices for depressed primary care patients improve quality of care, health outcomes, and employment.Design Randomized controlled trial initiated from June 1996 to March 1997.Setting Forty-six primary care clinics in 6 US managed care organizations.Participants Of 27 332 consecutively screened patients, 1356 with current depressive symptoms and either 12-month, lifetime, or no depressive disorder were enrolled.Interventions Matched clinics were randomized to usual care (mailing of practice guidelines) or to 1 of 2 QI programs that involved institutional commitment to QI, training local experts and nurse specialists to provide clinician and patient education, identification of a pool of potentially depressed patients, and either nurses for medication follow-up or access to trained psychotherapists.Main Outcome Measures Process of care (use of antidepressant medication, mental health specialty counseling visits, medical visits for mental health problems, any medical visits), health outcomes (probable depression and health-related quality of life [HRQOL]), and employment at baseline and at 6- and 12-month follow-up.Results Patients in QI (n = 913) and control (n = 443) clinics did not differ significantly at baseline in service use, HRQOL, or employment after nonresponse weighting. At 6 months, 50.9% of QI patients and 39.7% of controls had counseling or used antidepressant medication at an appropriate dosage (P