Rubenstein Lisa V, Chaney Edmund F, Ober Scott, Felker Bradford, Sherman Scott E, Lanto Andy, Vivell Susan
Department of Medicine and Health Services Research, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Fam Syst Health. 2010 Jun;28(2):91-113. doi: 10.1037/a0020302.
Translating Initiatives in Depression into Effective Solution (TIDES) aimed to translate research-based collaborative care for depression into an approach for the Veterans Health Administration (VA). SITES: Three multistate administrative regions and seven of their medium-sized primary care practices.
Researchers assisted regional leaders in adapting research-based depression care models using evidence-based quality improvement (EBQI) methods.
We evaluated model fidelity and impacts on patients. Trained nurse depression care managers collected data on patient adherence and outcomes.
Among 72% (128) of the 178 patients followed in primary care with depression care manager assistance during the 3-year study period, mean PHQ-9 scores dropped from 15.1 to 4.7 (p < .001). A total of 87% of patients achieved a PHQ-9 score lower than 10 (no major depression). 62% achieved a score lower than six (symptom resolution). Care managers referred 28% (50) TIDES patients to mental health specialty (MHS). In the MHS-referred group, mean PHQ-9 scores dropped from 16.4 to 9.0 (p < .001). A total of 58% of MHS-referred patients achieved a PHQ-9 score lower than 10, and 40%, a score less than 6. Over the 2 years following the initial development phase reported here, national policymakers endorsed TIDES through national directives and financial support.
TIDES developed an evidence-based depression collaborative care prototype for a large health care organization (VA) using EBQI methods. As expected, care managers referred sicker patients to mental health specialists; these patients also improved. Overall, TIDES achieved excellent overall patient outcomes, and the program is undergoing national spread.
将抑郁症治疗倡议转化为有效解决方案(TIDES)旨在将基于研究的抑郁症协作护理转化为退伍军人健康管理局(VA)的一种方法。地点:三个多州行政区及其七个中等规模的初级保健机构。
研究人员协助地区领导人采用循证质量改进(EBQI)方法调整基于研究的抑郁症护理模式。
我们评估了模式的保真度及其对患者的影响。经过培训的护士抑郁症护理经理收集了患者依从性和治疗结果的数据。
在为期3年的研究期间,在初级保健中接受抑郁症护理经理协助随访的178名患者中有72%(128名),患者健康问卷-9(PHQ-9)平均得分从15.1降至4.7(p<.001)。共有87%的患者PHQ-9得分低于10(无重度抑郁症)。62%的患者得分低于6(症状缓解)。护理经理将28%(50名)的TIDES患者转诊至心理健康专科(MHS)。在转诊至MHS的患者组中,PHQ-9平均得分从16.4降至9.0(p<.001)。共有58%转诊至MHS的患者PHQ-9得分低于10,40%的患者得分低于6。在本文报告的初始开发阶段后的两年里,国家政策制定者通过国家指令和财政支持认可了TIDES。
TIDES使用EBQI方法为一个大型医疗保健机构(VA)开发了一个基于证据的抑郁症协作护理原型。正如预期的那样,护理经理将病情较重的患者转诊至心理健康专家处;这些患者也有所改善。总体而言,TIDES取得了出色的总体患者治疗效果,该项目正在全国推广。