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，然而这些策略的采用令人失望。本有效性研究提出了一项分组随机试验，目的是治疗分析，以测试两种不同的方法来改善社区初级保健实践中抑郁症的质量（与常规护理相比）。这两项干预措施都旨在提高医生对抑郁症护理最佳实践的使用。Dep/QI使用QI模型针对抑郁症，该模型以前成功地为实践提供了启动变革和实施循证抑郁症护理工具的过程。副/QI协调员将与该部门的实践一起启动QI程序来处理抑郁症护理。副主任/精神健康促进协调员将与每个诊所合作六个月以上，并协助精神健康促进小组开展活动，加强小组在诊所内发起抑郁症干预措施的能力。Chron/QI干预具有更广泛的重点，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疾病提供循证护理。Chron/QI将纳入一个创新的多方法评估过程（MAP），以解决提高诊所提供抑郁症慢性护理的能力以及在诊所业务中进行和维持变革的能力的关键障碍。MAP过程已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促进者将与实践合作，处理MAP评估的信息，并组成包括关键利益相关者（包括患者）在内的QI团队，以解决实践的组织功能和办公系统的开发问题，以支持抑郁症护理的最佳实践。试验终点将在基线和6个月时测量，以评估采用情况，在12个月和18个月时评估干预效果的可持续性。终点将包括与慢性护理模式相一致的实践结构和过程的变化措施，并通过图表审计评估抑郁症患者接受的抑郁症护理的“最佳实践”。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的是试图了解初级保健医生和实践如何在初级保健的竞争需求中确定和采取相对优先的抑郁症护理措施。

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.