QUALITY IMPROVEMENT FOR DEPRESSION

政策制定者不知道如何改变结构和过程， 初级保健提供治疗， 改善与重大疾病相关的功能障碍 抑郁症是全球第四大残疾原因。 到 针对这一问题，我们提出了抑郁症的质量改进， （QID）。 QID的具体目标是：（1）提供综合 分析了四个不同但相关的主要 护理干预，以改善抑郁症治疗期间的急性， （2）护理的持续和维持阶段;（3）估计 高质量的初级保健抑郁症治疗对长期 残疾。 在QID合作的早期阶段， 四个独立的质量改进设想的调查员 规划并实施了协调一致的战略， 在108个初级保健中进行招募、干预和数据收集 网络和员工模式的HMO、IPA、PPO和混合模式的诊所 设置. 除了共同的基准组织和提供商之外， 数据，QID调查人员正在收集80多个常见变量， 1，980名重度抑郁症患者在三个波中的每一个 第一年此应用程序寻求支持，以进行有效性 标准化患者随访后联合数据库中的分析 第二年，在四个项目中。 这种努力是必要的 了解四种传播干预措施的“全貌”， 这是可行的，以整合在各种实践环境， 和人口，影响护理的质量和结果， 确定它们是否在一段时间内改善结果的能力 对政策制定者有意义。 这些分析将为政策辩论提供信息 关于有效的心理健康治疗， 抗抑郁药物和心理治疗效果的评估 长期的残疾问题。

Policy makers do not know how to alter the structure and process of primary care to provide treatment which will improve and sustain improvement in the functional impairment associated with major depression, the fourth leading cause of disability worldwide. To address this problem, we propose the Quality Improvement for Depression (QID). The specific aims of QID are: (1) to provide integrated analyses of the long term impact of four distinct but related primary care interventions to improve depression treatment during the acute, continuation, and maintenance phase of care; and (2) to estimate the effects of high quality primary care depression treatment on long term disability. In the early stages of QID collaboration, funded investigators of four separately conceived quality improvement interventions planned and implemented a coordinated strategy for recruitment, intervention, and data collection in 108 primary care clinics in network and staff model HMOs, IPAs, PPOs, and mixed model settings. In addition to common baseline organizational and provider data, QID investigators are collecting over 80 common variables from 1,980 patients with major depression at each of three waves across the first year. This application seeks support to conduct effectiveness analyses in the combined database after standardizing patient follow-up during the second year across the four projects. This effort is needed to understand the "big picture" of how four dissemination interventions which are feasible to integrate across a variety of practice settings and populations, impact the quality and outcome of care, with sufficient power to determine whether they improve outcomes over a duration meaningful to policy makers. The analyses will inform policy debates about effective mental health treatment by providing generalizable estimates of the effect of antidepressant medication and psychotherapy on disability over the long term.