IMPROVING CARE FOR DEPRESSION

重度抑郁症很常见，使人衰弱，认识不足， 治疗不足大多数接受治疗的人都是在 在初级保健环境中。抑郁症临床实践指南， 结合基于团队的质量改进（QI）， 它们为改善临床护理提供了一个潜在的有价值的工具， 抑郁症患者的健康状况。本研究的主要目的是 以确定基于团队的质量改进方法是否更 比单独分发指南更有效， 重度抑郁症患者的初级护理指南。作为 第二个目的，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模型更集中管理，而另一个 更多的是本地管理。因此，我们将了解如何，是否，以及为什么 基于团队的QI工作。 我们提出了一个随机临床试验，在9个小组实践地点比较 QI的中央专家（CE）形式和QI的本地同行（LP）形式， 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 治疗抑郁症我们将在6中评估这两个QI模型 研究中心（北方Kaiser Permanente内的4个自治机构） 加州和塞普尔韦达VA医疗中心的2家公司（团队）实践） 对照对照条件-指导原则分布-在3个地点（2个Kaiser 和1塞普尔韦达VA实践）。QI方法将在 为期10个月。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， 分布在各研究中心。我们会评估病人的健康状况 （包括抑郁症的严重程度）和护理过程的质量 两个样本都有抑郁症我们将随访这些患者12年， 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。我们还将评估健康和成本结果， 满足于照顾。我们还将评估医疗保健提供者 态度和知识，以及任何组织特征， 影响干预措施的成功。这项研究将产生新的 关于抑郁症指南实施的知识，质量 改善方法，以及抑郁症护理的障碍和资源， 初级保健机构。

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.