实施州立精神卫生整合计划中的协作式护理后的学习曲线。
The Learning Curve After Implementation of Collaborative Care in a State Mental Health Integration Program.
机构信息
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Carlo, Unützer); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Jeng, Bao).
出版信息
Psychiatr Serv. 2019 Feb 1;70(2):139-142. doi: 10.1176/appi.ps.201800249. Epub 2018 Nov 20.
OBJECTIVE
This study examined organizational variability of process-of-care and depression outcomes at eight community health centers (CHCs) in the years following implementation of collaborative care (CC) for depression.
METHODS
The authors used 8 years of observational data for 13,362 unique patients at eight CHCs that participated in Washington State's Mental Health Integration Program. Organization-level changes in depression and process-of-care outcomes over time were studied.
RESULTS
On average, depression outcomes improved for the first 2 years before improvement slowed, peaking at year 5. Significant organization-level variation was noted in outcomes. Improvements in depression outcomes tended to follow process-of-care measures.
CONCLUSIONS
Findings suggest that it may take 2 years after implementation of CC to fully observe depression outcome improvement at an organization level. Substantial variation between organizations in depression outcomes over time suggests that sustained attention to processes of care may be necessary to maintain initially achieved gains.
目的
本研究考察了在实施抑郁共病管理（CC）后的几年中，8 家社区卫生中心（CHC）的护理过程和抑郁结果的组织变异性。
方法
作者使用了 8 年时间观察了参与华盛顿州心理健康整合计划的 8 家 CHC 中 13362 名独特患者的数据。研究了随时间推移的抑郁和护理过程结果的组织层面变化。
结果
平均而言，抑郁结果在头 2 年有所改善，然后改善速度放缓，在第 5 年达到峰值。结果在组织层面上存在显著的差异。抑郁结果的改善往往伴随着护理过程措施的改善。
结论
研究结果表明，在组织层面上观察到 CC 实施后 2 年才能完全观察到抑郁结果的改善。随着时间的推移，各组织之间在抑郁结果方面存在大量差异，这表明需要持续关注护理过程，以维持最初取得的成果。
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