Implementation and Maintenance of Quality Improvement for Treating Depression in Primary Care

Department of Psychiatry and Behavioral Sciences, University of Washington Seattle, Seattle, Washington, United States
Psychiatric Services (Impact Factor: 2.41). 02/2006; 57(1):48-55. DOI: 10.1176/
Source: PubMed


Little is known about the long-term success of quality improvement efforts for the treatment of depression in primary care. This study assessed factors associated with the successful implementation, maintenance, and spread of such efforts.
The authors conducted an independent process evaluation of data from monthly progress reports and 18-month telephone interviews from multidisciplinary quality improvement teams in 17 diverse primary care organizations that participated in the Institute for Healthcare Improvement's Breakthrough Series for Depression from February 2000 through March 2001.
All sites made changes toward improving care in three of six categories: delivery system redesign, self-management strategies, and information systems. The changes that were most commonly viewed as major successes were delivery system changes (ten sites, or 59 percent) and information system changes (nine sites, or 53 percent); these types of changes were also the most often sustained over time (ten sites, or 59 percent, and 16 sites, or 94 percent, respectively). Fifteen sites made changes in decision support, community linkages, and health system support but were less likely to view these changes as major successes or to sustain them. Organizational structure and leadership support were the most common facilitators. Staff resistance, time constraints, and information technology were the most common barriers. Implementation strategies varied with sets of barriers.
Despite substantial challenges, there was evidence of broad success at implementation and maintenance of quality improvement for depression treatment in primary care.

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Available from: Marjorie L Pearson, Sep 17, 2015
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    • "Our study can be compared to the Depression QIC, organised by the Institute for Healthcare Improvement in the United States in 2000–2001 and based on Wagner’s Chronic Care Model (CCM) [40]. The American QIC, also involving seventeen general practices, led to successful changes in the depression delivery and information system, which were also the most often sustained over time [41]. Organisational structure and leadership support were the most common facilitators, while staff resistance, time constraints, and information technology were the most common barriers. "
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