IMPROVING CARE FOR DEPRESSION

严重的抑郁症很常见，使人虚弱，被忽视，而且 没有得到充分的对待。大多数接受治疗的人都是单独接受治疗的 在初级保健环境中。抑郁症的临床实践指南，在 与基于团队的质量改进(QI)相结合实施 它们为改善临床护理提供了一个潜在的有价值的工具 抑郁症患者的健康结果。这项研究的主要目的是 确定基于团队的质量改进方法是否比 比单独分发指南更有效地提高了对 重度抑郁症患者初级保健指南。作为一名 次要目的是，我们将评估基于团队的QI的两个常见变体。 其中一个基于团队的QI模型更加集中管理，而另一个 更多的是在当地管理。因此，我们将了解如何、是否以及为什么 基于团队的QI奏效。 我们提出了一项随机临床试验，在9个分组实习地点进行比较 QI的中央专家(CE)形式和QI的本地同行(LP)形式 单独分发作为实现最近发布的 卫生保健政策和研究机构临床实践指南 治疗初级保健中的抑郁症。我们将在6个月中评估这两个QI模型 站点(在北方的Kaiser Permanente内有4个自治实践 加利福尼亚州和塞普尔韦达退伍军人医疗中心的2家公司(团队) 在3个站点(2个Kaiser)中对照控制条件--指南分布 和1个赛普尔吠陀VA练习)。QI方法将在以下方面实施 10个月的期限。为了评估QI方法的有效性，我们 将在干预后期间招募750名抑郁症患者， 分布在多个研究地点。我们将评估患者的健康状况 (包括抑郁症的严重程度)和护理过程的质量 对于两个样本的抑郁症。我们将对这些患者进行12年的跟踪调查 几个月来确定他们的健康和成本结果以及他们的满意度 小心翼翼。我们还将评估健康和成本结果及其 护理的满足感。我们还将评估医疗保健提供者 态度和知识以及任何符合以下条件的组织特征 影响干预措施的成功。因此，该研究将产生新的 了解抑郁症、质量指南的实施情况 抑郁症护理的障碍和资源 初级保健设置。

Major depression is common, debilitating, underrecognized, and undertreated. Most individuals who do get treatment are cared for solely in primary care settings. Clinical practice guidelines for depression, in combination with team-based quality improvement (QI) for implementing them, offer a potentially valuable tool for improving clinical care and health outcomes for depressed patients. The main purpose of this study is to determine whether team-based quality improvement approaches are more effective than guideline distribution alone for increasing adherence to guidelines for primary care patients with major depression. As a secondary purpose, we will assess two common variants of team-based QI. One of the team-based QI models is more centrally-managed, while the other is more locally managed. We will thus learn about how, whether, and why team-based QI works. We propose a randomized clinical trial in 9 group-practice sites comparing the central expert (CE) form of QI and the local peer (LP) form of QI to distribution alone as methods for implementing the recently-published Agency for Health Care Policy and Research clinical practice guidelines for depression in primary care. We will evaluate the two QI models in 6 sites (4 autonomous practices within Kaiser Permanente of Northern California and 2 firm (team) practices at the Sepulveda VA Medical Center) against a control condition--guideline distribution--in 3 sites (2 Kaiser and 1 Sepulveda VA practice). The QI approaches will be implemented over a 10 month period. To evaluate the effectiveness of the QI approaches, we will enroll 750 depressed patients during the post intervention period, distributed across study sites. We will assess patient health status (including severity of depression) and the quality of the process of care for depression for both samples. We will follow these patients for 12 months to determine their health and cost outcomes and their satisfaction with care. We will also assess health and cost outcomes and their satisfaction with care. We will also assess health care provider attitudes and knowledge, as well as any organizational features that affect the success of the interventions. The study will thus generate new knowledge about guidelines implementation for depression, quality improvement methods, and the barriers and resources for depression care in primary care settings.