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HSR&D 2004 National Meeting Abstracts

3002. The Chronic Care Model and Evidence-Based Collaborative Care for Depression
Edmund F Chaney, PhD, NW HSR&D COE, M Garcia-Maldonado, Beaumont CBOC, J Fotiades, Bronx VAMC, S Vivell, GLAHS HSR&D COE, K Vollen, VISN 23 TIDES Project, P Beamon, VA GLAHS

Workshop Objectives: An action research partnership among VISNs 10, 16, 23 and depression care researchers in Seattle and Los Angeles carried out the “TIDES” study to improve depression care in VA, specifically recognition and treatment of depression in primary care.

Workshop Activities: Five workgroups, reflecting elements of the Chronic Illness Care Model, carried out the project: Care Management and Patient Self-Management Support, Clinician Education/Decision Support, Information Systems, Collaboration, and Senior Leaders. The intervention consisted of primary care treatment enhanced by nurse care management, patient self-management support, provider education, and active collaboration between primary care and mental health. To date, over 200 primary care patients with baseline PHQ-9 scores suggesting major depression have participated in collaborative care management for six months. 85% of patients were managed in primary care for their depressive symptoms and demonstrated a high degree of adherence to treatment. Depression severity scores showed sustained improvement. Patient satisfaction was high, with fewer than 8% discontinuing depression care management.

Target Audience: Using the Chronic Illness Care Model to structure evidence-based quality improvement for collaborative care of depression met or exceeded all expectations. The panel will discuss how the project workgroup structure contributed to this outcome and how this structure could be used in other spread initiatives.

Audience Familiarity: This project demonstrates that the VA VISN system can successfully implement collaborative care for depression. The project demonstrates the development of a tool kit, web-based resources, and methods of spread that minimize staff time and costs and maximize care model fidelity and ongoing evaluation.