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，但这些策略的采用一直令人失望。这项有效性研究提出了一组随机试验，意在进行治疗分析，以测试社区初级保健实践中两种不同的提高抑郁症质量的方法(与常规护理相比)。这两种干预措施的目的都是为了改善医生对抑郁症护理最佳实践的使用。Dep/QI以抑郁症为目标，使用QI模型，该模型以前成功地为实践提供了发起改变和实施基于证据的抑郁症护理工具的过程。一个Dep/QI辅导员将与这个手臂的实践合作，启动QI程序来解决抑郁症的护理问题。副主任/QI协调员将在六个月内与每个实践一起工作，并协助QI团队开展活动，以加强团队在实践中启动抑郁干预的能力。Chron/QI干预具有更广泛的关注点，旨在提高组织实施慢性护理系统的能力，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)，以解决提高诊所为抑郁症提供长期护理的能力以及在诊所业务中进行和维持变化的能力的关键障碍。MAP程序已被成功地用于评估和反馈关于预防服务和糖尿病护理的实践、组织和运作的信息。QI协调员将与实践合作，处理来自MAP评估的信息，并组成一个包括关键利益相关者(包括患者)的QI团队，以解决实践的组织职能和支持最佳实践抑郁症护理的办公室系统的开发。试验终点将在基线和6个月时测量，以评估采用情况，并在12个月和18个月时测量，以评估干预效果的可持续性。终点将包括与慢性护理模式一致的实践结构和流程的变化的衡量标准，以及通过图表审计评估的抑郁症患者接受抑郁症护理的“最佳做法”。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，以及实践如何使用两种干预措施，以及干预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将寻求了解初级保健医生和实践如何在初级保健相互竞争的需求中确定抑郁症护理的相对优先事项并采取行动。

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.