Practice Redesign to Improve Depression Care - PRIDE Care

描述（由申请人提供）：临床试验已经证明了抑郁症初级保健管理策略的有效性，但这些策略的采用令人失望。 这项有效性研究提出了一项组随机试验，目的是治疗分析，以测试两种不同的方法来提高抑郁症的质量（与常规护理相比），在以社区为基础的初级保健实践。 这两种干预措施都旨在改善医生对抑郁症护理最佳实践的使用。 该部门/QI使用QI模型来治疗抑郁症，该模型以前曾成功地为实践提供了一个启动变革和实施循证抑郁症护理工具的过程。 副/QI促进者将与该部门的实践合作，启动QI程序，以解决抑郁症护理问题。 副/QI协调员将与每个诊所合作六个月，并协助QI团队开展活动，以加强团队在诊所内启动抑郁干预的能力。 Chron/QI干预措施的重点更广泛，旨在提高组织实施慢性病护理系统的能力，使初级保健医生能够为抑郁症和其他慢性病提供循证护理。 Chron/QI将纳入创新的多方法评估流程（MAP），以解决提高实践能力的关键障碍，为抑郁症提供长期护理，并在实践操作中进行和维持变革。 MAP过程已成功地用于评估和反馈信息的实践组织和功能的预防服务和糖尿病护理。 QI促进者将与实践合作，处理来自MAP评估的信息，并组建一个包括关键利益相关者（包括患者）的QI团队，以解决实践的组织功能和办公系统的开发，以支持最佳实践抑郁症护理。 将在基线和6个月时测量试验终点，以评估采用情况，并在12和18个月时测量试验终点，以评估干预效果的可持续性。 终点将包括实践结构和过程的变化措施与慢性病护理模式一致，并证明“最佳实践”的抑郁症患者接受的抑郁症护理评估图表审计。 多方法评估将分别分析所有定性和定量数据，以了解干预措施的哪些组成部分最有效，如何进一步改进，以及实践如何使用这两种干预措施，以及干预措施组成部分如何与关键实践特征相互作用。 多方法评估的一个具体目标是寻求了解初级保健医生和实践如何在初级保健的竞争性需求中确定并采取行动，以确定抑郁症护理的相对优先级。

DESCRIPTION (provided by applicant): Clinical trials have demonstrated the effectiveness of strategies for primary care management of depression, yet adoption of these strategies has been disappointing. This effectiveness study proposes a group randomized trial with intention to treat analysis to test two different approaches to quality improvement for depression (compared to usual care) in community-based primary care practices. Both interventions will be aimed at improving physician use of best practices for depression care. The Dep/QI targets depression using a QI model that was previously successful in providing practices with a process to initiate change and implement evidence-based depression care tools. A Dep/QI facilitator will work with practices in this arm to initiate QI procedures to address depression care. The Dep/QI facilitator will work with each practice over six months and assist the QI team with activities to strengthen the ability of the team to initiate depression interventions within the practice. The Chron/QI intervention assumes a broader focus and seeks to improve organizational capacity to implement chronic care systems that enable primary care physicians to provide evidence-based care for depression as well as other chronic conditions. The Chron/QI will incorporate an innovative Multimethod Assessment Process (MAP) to address critical barriers to improving a practice's capacity for providing chronic care for depression and capacity for making and sustaining change in practice operations. The MAP process has been used successfully to assess and feedback information on practice organization and functioning for preventive services and for diabetes care. A QI facilitator will work with the practices to process the information from the MAP assessment and form a QI team that includes key stakeholders (including patients) to address both organizational function of the practice and the development of office systems to support best practices depression care. Trial endpoints will be measured at baseline and six months to assess adoption and at 12 and 18 months to assess sustainability of intervention effects. Endpoints will include measures of change in practice structure and processes consistent with the chronic care model and demonstrated "best practices" for depression care received by patients with depression as assessed by chart audit. A multimethod assessment will analyze all qualitative and quantitative data separately to understand which components of the interventions were most effective and how they might be further improved, as well as how the practices used the two interventions and how intervention components interacted with key practice characteristics. A specific aim of the multimethod assess will seek to understand how primary care physicians and practices determine and act on the relative priority of depression care among the competing demands of primary care.