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

HealthPartners Institute

Status: Completed

Conditions: Major Depression

Treatments: Other: DIAMOND depression care model

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT00781703

R01MH080692 (U.S. NIH Grant/Contract)

PAR-06-039

Details and patient eligibility

About

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. 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. 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. 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. 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.

Full description

The study will use a multiple baseline across settings with staggered implementation to test the effects of changed reimbursement and facilitated organizational change on the use and sustainability of evidenced-based care processes for patients with depression. The study will also test the effect of the care process changes on changes in depression symptoms, healthcare costs, and work productivity.

Enrollment: 2,631 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

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

Exclusion criteria

• comorbid psychiatric conditions

Trial design

Primary purpose: Health Services Research

Allocation: N/A

Interventional model: Single Group Assignment

Masking: Single Blind

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2,631 participants in 1 patient group

DIAMOND Care Model

Other group

Description:

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.

Treatment:

Other: DIAMOND depression care model