Costs Associated with Providing Depression Care in the Primary Care Setting
Substantial evidence indicates that improved depression care and outcomes can be achieved by implementing evidence-based, cost-effective care models. Such models restructure how mental health care is delivered to primary care patients and require substantial change, as well as investment of organizational and clinical resources in a quality improvement (QI) process. This study reports on organizational costs associated with depression care quality improvement, specifically introducing an evidence-based depression model - Translating Initiatives in Depression into Effective Solutions (TIDES) Project - into VA primary care settings. Investigators analyzed TIDES data from five participating states (South Dakota, Wisconsin, Ohio, Florida, Texas), which included project time commitments and costs for 86 clinical QI and 42 technical expert participants from 4/26/00 to 6/4/04. The clinical team, including clinical managers and regional and QI leaders, were the project's decision-makers, while the technical expert participants supported the decision-making process and tool development.
Findings show that organizational costs for the TIDES project (in the locations studied) were significant, and should be accounted for in planning the implementation of evidence-based depression care. Clinical participants spent 1,086 hours at a cost of $84,438, while technical experts spent 2,147 hours at a cost of $197,787. Both technical and clinical participants contributed most of their hours (76% and 68%, respectively) during the preparation and design phases, with decreases as the project moved toward routine care. During the preparation and design phase, leadership and collaboration activities accounted for the greatest number of hours, followed by provider education and clinical informatics. Among all types of activities, in-person meetings and conference calls consumed the most resources in terms of both hours and costs for clinical participants (905 hours and $75,861) and technical experts (1,413 hours and $103,100).
Liu CF, Rubenstein LV, Kirchner JE, Fortney JC, Perkins MW, Ober SK, Pyne JM, and Chaney EF. The organizational cost of quality improvement for depression care. Health Services Research February 2009; 44(1):225-244.
This study was funded by HSR&D. Drs. Liu, Perkins and Chaney are with HSR&D's Northwest Center for Outcomes Research in Older Adults, Seattle; Drs. Fortney and Pyne are with HSR&D's Center for Mental Healthcare and Outcomes Research in Little Rock. Drs. Kirchner and Rubenstein are part of VA/HSR&D's Mental Health Quality Enhancement Research Initiative (MH-QUERI), which developed the TIDES project.