Evaluation of a Natural Experiment to Improve Statewide Depression Care in Minnesota (MN)

NCT00781703 | Completed

• 2 other identifiers: PAR-06-039R01MH080692
• Study Type: interventional
• Target: 2,631
• Locations: 0 countries
• Sites: N/A

Brief Summary

The study will evaluate a unique natural experiment that aims to transform the primary care of patients with depression. The experiment's aim is to cause statewide implementation of an evidence-based care model for depression by changing the reimbursement system and by using an established regional collaborative (the Institute for Clinical Systems Improvement) to both facilitate the model's widespread use and certify that medical groups have implemented it. Study hypotheses include the following:

1. 1.Newly treated depressed patients in medical groups that have implemented the new reimbursement and facilitation will report receiving higher rates of best care processes than such patients in these medical groups before implementation.
2. 2.Rates of best care practices reported to be received by newly treated depressed patients two years after each medical group implements changes will be maintained at least at the rate reported by patients one year post implementation.
3. 3.Newly treated depressed patients in medical groups that have participated in the new reimbursement and facilitation will have greater improvement in depression symptoms and work productivity and lower healthcare costs than such patients in groups before participation.
4. 4.Medical group measures of priority for improving depression care, capability to manage change, and practice systems will be predictive of more patient-reported best care processes, both at one point in time and in change over time.

Conditions

Major Depression

Outcome Measures

Primary Outcomes (1)

• Rates of best care processes

  baseline, 6 months

Secondary Outcomes (1)

• Improvement in depression symptoms, work productivity and total healthcare costs

  baseline, 3 months, 6 months, 1 year

Study Arms (1)

DIAMOND Care Model

OTHER

Patients in activated clinic sites will receive the DIAMOND depression care model, including a care manager, frequent use of the Patient Health Questionnaire-9 (PHQ9), treatment adjustment as indicated, psychiatric consultation, relapse prevention.

Other: DIAMOND depression care model

Interventions

DIAMOND depression care model OTHER

Patients in activated clinic sites will receive the DIAMOND depression care model, including a care manager, frequent use of the PHQ9, treatment adjustment as indicated, psychiatric consultation, relapse prevention.

DIAMOND Care Model

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• major depression
• Patient Health Questionaire (PHQ-9) \> 9
• primary care management of depression

You may not qualify if:

• comorbid psychiatric conditions

Sponsors & Collaborators

• HealthPartners Institute: lead
• National Institute of Mental Health (NIMH): collaborator

MeSH Terms

Conditions

Depressive Disorder, Major

Condition Hierarchy (Ancestors)

Depressive Disorder; Mood Disorders; Mental Disorders

Study Officials

• Leif I Solberg, MD

  HealthPartners Institute

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: October 28, 2008
• First Posted: October 29, 2008
• Study Start: February 1, 2008
• Primary Completion: June 1, 2012
• Study Completion: February 1, 2014
• Last Updated: July 15, 2014

Record last verified: 2014-07