Youth Partners in Care: Depression and Quality Improvement

NCT02030782 | Completed DMC

• 1 other identifier: HS009908
• Study Type: interventional
• Target: 418
• Locations: 1 country
• Sites: 5

Brief Summary

This randomized effectiveness trial evaluates a quality improvement intervention aimed at providing access to evidence-based depression treatments (particularly cognitive-behavior therapy for depression and or pharmacotherapy) through primary care for youth ages 13-21, as compared to enhanced usual care. The major hypothesis is that the quality improvement intervention will be associated with improved outcomes, relative to enhanced usual care.

Conditions

Depression

Keywords

depression; quality improvement; treatment; adolescents

Outcome Measures

Primary Outcomes (1)

• Self-reported depressive symptoms on the CES-D (Center for Epidemiologic Studies Depression Scale)

  6-months

Secondary Outcomes (3)

• mental health related quality of life as assessed using self-report on the Medical Outcomes Study Short Form 12 Health Survey.

  6 months, with follow up at 12 and 18 months

• satisfaction with care

  6 months with follow up at 12 and 18 months

• Rates of mental health care, counseling/psychotherapy, and medication treatment.

  6-months with follow-up at 12 and 18 months

Study Arms (2)

Usual Care

ACTIVE COMPARATOR

Patients received usual care through primary care, enhanced by provider education regarding depression evaluation and management (1-2 hour training, plus study manual)

Other: Usual Care

Quality Improvement for Depression

EXPERIMENTAL

Major intervention components included a) expert leader teams who planned and implemented the intervention at each clinic, b) care managers who supported primary care clinicians with depression evaluation and management, c) access to cognitive-behavior therapy for depression within each primary care clinic, and d) patient and provider choice regarding treatment modality.

Other: Quality Improvement (QI) for depression

Interventions

Quality Improvement (QI) for depression OTHER

Major intervention components included a) expert leader teams who planned and implemented the intervention at each clinic, b) care managers who supported primary care clinicians with depression evaluation and management, c) access to cognitive-behavior therapy for depression within each primary care clinic, and d) patient and provider choice regarding treatment modality.

Quality Improvement for Depression

Usual Care OTHER

Usual care enhanced by provider education regarding depression evaluation and management

Usual Care

Eligibility Criteria

• Age: 13 Years - 21 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Met either of two criteria: 1) endorsed "stem items" for major depression or dysthymia from the 12-month Composite International Diagnostic Interview(CIDI-12,2.1) modified slightly to conform to diagnostic criteria for adolescents, 1-week or more of past-month depressive symptoms, and a total Center for Epidemiological Studies- Depression Scale(CES-D)40 score ≥ 16, or 2) CES-D score ≥ 24.
• Age 13-21
• Presented at primary care clinic

You may not qualify if:

• not English-speaking
• provider not in study
• sibling already in study
• completed eligibility screener previously

Sponsors & Collaborators

• Agency for Healthcare Research and Quality (AHRQ): lead
• RAND: collaborator
• Kaiser Permanente: collaborator
• University of Pittsburgh: collaborator
• Venice Family Clinic: collaborator

Study Sites (5)

University of California

Los Angeles, California, 90024, United States

Location

Kaiser Permanente Los Angeles Medical Center

Los Angeles, California, United States

Location

Venice Family Clinic

Venice, California, United States

Location

Ventura County Medical Center

Ventura, California, United States

Location

University of Pittsburgh

Pittsburgh, Pennsylvania, United States

Location

Related Publications (10)

• Asarnow JR, Jaycox LH, Anderson M. Depression among youth in primary care models for delivering mental health services. Child Adolesc Psychiatr Clin N Am. 2002 Jul;11(3):477-97, viii. doi: 10.1016/s1056-4993(02)00006-8.

  PMID: 12222079 BACKGROUND

• Wells KB, Kataoka SH, Asarnow JR. Affective disorders in children and adolescents: addressing unmet need in primary care settings. Biol Psychiatry. 2001 Jun 15;49(12):1111-20. doi: 10.1016/s0006-3223(01)01113-1.

  PMID: 11430853 BACKGROUND

• Asarnow JR, Jaycox LH, Tang L, Duan N, LaBorde AP, Zeledon LR, Anderson M, Murray PJ, Landon C, Rea MM, Wells KB. Long-term benefits of short-term quality improvement interventions for depressed youths in primary care. Am J Psychiatry. 2009 Sep;166(9):1002-10. doi: 10.1176/appi.ajp.2009.08121909. Epub 2009 Aug 3.

  PMID: 19651711 RESULT

• Asarnow JR, Jaycox LH, Duan N, LaBorde AP, Rea MM, Murray P, Anderson M, Landon C, Tang L, Wells KB. Effectiveness of a quality improvement intervention for adolescent depression in primary care clinics: a randomized controlled trial. JAMA. 2005 Jan 19;293(3):311-9. doi: 10.1001/jama.293.3.311.

  PMID: 15657324 RESULT

• Jaycox LH, Asarnow JR, Sherbourne CD, Rea MM, LaBorde AP, Wells KB. Adolescent primary care patients' preferences for depression treatment. Adm Policy Ment Health. 2006 Mar;33(2):198-207. doi: 10.1007/s10488-006-0033-7.

  PMID: 16502131 RESULT

• Asarnow JR, Jaycox LH, Duan N, LaBorde AP, Rea MM, Tang L, Anderson M, Murray P, Landon C, Tang B, Huizar DP, Wells KB. Depression and role impairment among adolescents in primary care clinics. J Adolesc Health. 2005 Dec;37(6):477-83. doi: 10.1016/j.jadohealth.2004.11.123.

  PMID: 16310125 RESULT

• Ngo VK, Asarnow JR, Lange J, Jaycox LH, Rea MM, Landon C, Tang L, Miranda J. Outcomes for youths from racial-ethnic minority groups in a quality improvement intervention for depression treatment. Psychiatr Serv. 2009 Oct;60(10):1357-64. doi: 10.1176/ps.2009.60.10.1357.

  PMID: 19797376 RESULT

• Tang L, Duan N, Klap R, Asarnow JR, Belin TR. Applying permutation tests with adjustment for covariates and attrition weights to randomized trials of health-services interventions. Stat Med. 2009 Jan 15;28(1):65-74. doi: 10.1002/sim.3453.

  PMID: 18937226 RESULT

• Goldstein RB, Asarnow JR, Jaycox LH, Shoptaw S, Murray PJ. Correlates of "non-problematic" and "problematic" substance use among depressed adolescents in primary care. J Addict Dis. 2007;26(3):39-52. doi: 10.1300/J069v26n03_05.

  PMID: 18018807 RESULT

• Fordwood SR, Asarnow JR, Huizar DP, Reise SP. Suicide attempts among depressed adolescents in primary care. J Clin Child Adolesc Psychol. 2007 Jul-Sep;36(3):392-404. doi: 10.1080/15374410701444355.

  PMID: 17658983 RESULT

MeSH Terms

Conditions

Depression

Interventions

Quality Improvement

Condition Hierarchy (Ancestors)

Behavioral Symptoms; Behavior

Intervention Hierarchy (Ancestors)

Engineering; Technology, Industry, and Agriculture; Quality of Health Care; Health Services Administration

Study Officials

• Joan R Asarnow, PhD

  University of California, Los Angeles

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 19, 2012
• First Posted: January 9, 2014
• Study Start: October 1, 1999
• Primary Completion: December 1, 2003
• Study Completion: December 1, 2003
• Last Updated: January 9, 2014

Record last verified: 2008-12

Locations

US (5)