Collaborative care for depression is a highly evidence-based care model that improves the quality of care for depression in primary care but has rarely been sustained or spread outside of research projects. This objective is a preparatory step toward national implementation. This project will support Veterans Healthcare Network (VISNs) as learning organizations in the area of depression care improvement, and will ultimately support as many as 8% to 10% of veterans nationally in improving their health and quality of life. This project hypothesizes that research-based care models can be implemented successfully in practice if their benefits to patients, clinicians, and organizations are made apparent, their complexity is reduced, and their fit with local priorities is maximized. It will develop and implement sustainable collaborative care administration methods and test methods for spreading the model to new sites. This project is a continuation and expansion of Translating Initiatives for Depression into Effective Solutions (TIDES) Quality Enhancement Research Initiative (QUERI) implementation research project. In the depression collaborative care model, a nurse depression care manager (DCM) and mental health specialist (MHS) assist primary care physicians (PCPs) in the diagnosis and ongoing management of depressed patients. At a minimum, patients being followed in primary care receive follow-up calls from the DCM at one week, two weeks, 4-6 weeks, 8-12 weeks and 24 weeks. The collaboration takes place with full input from the patient regarding treatment preferences and includes telephone assessment and follow-up by the DCM, treatment plans based on depression algorithms selected by the PCP, regular supervision of the DCM by the MHS and consultation between the MHS and PCP as needed.

The investigators will use a randomized design to evaluate long term (18-month) cost effectiveness of TIDES collaborative care in six intervention clinics with fully-implemented collaborative care compared to three matched and randomly-assigned usual care clinics. A non-randomized quasiexperimental design (untreated control group with pretest and posttest) will be used to measure impacts on clinician performance, knowledge, and attitudes in 6 newly-implemented collaborative care intervention clinics compared to 6 matched usual care clinics. Process evaluation data on the costs and characteristics of spread, and pilot data on proposed VISN add-ons or changes to the TIDES collaborative care model will be collected. Finally, the investigators will prepare a national dissemination package that includes potential design choices for collaborative care as well as all necessary information, materials and methods.

Condition	Intervention	Phase
Depression	Behavior: Collaborative Care for Depression	Phase I

Further Study Details: 

Genders Eligible for Study:  Both

Criteria

• Patient has depression

Please refer to this study by ClinicalTrials.gov identifier  NCT00119028

Arkansas
      Central Arkansas VHS Eugene J. Towbin Healthcare Ctr, Little Rock, No Little Rock,  Arkansas,  72114-1706,  United States; Not yet recruiting
California
      VA Greater Los Angeles Health Care System, Sepulveda,  California,  91343,  United States; Recruiting
      VA Greater Los Angeles Health Care System, Sepulveda,  California,  91343,  United States; Not yet recruiting
Washington
      VA Puget Sound Health Care System, Seattle,  Washington,  98109,  United States; Not yet recruiting
      VA Puget Sound Health Care System, Seattle,  Washington,  98109,  United States; Not yet recruiting

Study ID Numbers:  MNT 03-215
Record last reviewed:  July 2005
Last Updated:  July 21, 2005
Record first received:  July 11, 2005
ClinicalTrials.gov Identifier:  NCT00119028
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2005-07-26