Smith Justin D, Fu Emily, Rado Jeffrey, Rosenthal Lisa J, Carroll Allison J, Atlas Jacob A, Carlo Andrew D, Burnett-Zeigler Inger, Jordan Neil, Brown C Hendricks, Csernansky John
Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA.
Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Contemp Clin Trials Commun. 2021 Jul 26;23:100823. doi: 10.1016/j.conctc.2021.100823. eCollection 2021 Sep.
The Collaborative Care Model (CoCM) is a well-established treatment for depression in primary care settings. The critical drivers and specific strategies for improving implementation and sustainment are largely unknown. Rigorous pragmatic research is needed to understand CoCM implementation processes and outcomes.
This study is a hybrid Type 2 randomized roll-out effectiveness-implementation trial of CoCM in 11 primary care practices affiliated with an academic medical center. The Collaborative Behavioral Health Program (CBHP) was developed as a means of improving access to effective mental health services for depression. Implementation strategies are provided to all practices. Using a sequential mixed methods approach, we will assess key stakeholders' perspectives on barriers and facilitators of implementation and sustainability of CBHP. The speed and quantity of implementation activities completed over a 30-month period for each practice will be assessed. Economic analyses will be conducted to determine the budget impact and cost offset of CBHP in the healthcare system. We hypothesize that CBHP will be effective in reducing depressive symptoms and spillover effects on chronic health conditions. We will also examine differential outcomes among racial/ethnic minority patients.
This study will elucidate critical drivers of successful CoCM implementation. It will be among the first to conduct economic analyses on a fee-for-service model utilizing billing codes for CoCM. Data may inform ways to improve implementation efficiency with an optimization approach to successive practices due to the roll-out design. Changes to the protocol and current status of the study are discussed.
协作护理模式（CoCM）是基层医疗环境中一种成熟的抑郁症治疗方法。改善其实施和维持的关键驱动因素及具体策略在很大程度上尚不清楚。需要进行严格的实用研究来了解CoCM的实施过程和结果。
本研究是一项混合型2类随机推广有效性-实施试验，在一家学术医疗中心附属的11家基层医疗诊所开展CoCM。协作行为健康项目（CBHP）是作为改善抑郁症有效心理健康服务可及性的一种手段而开发的。向所有诊所提供实施策略。采用序贯混合方法，我们将评估关键利益相关者对CBHP实施及可持续性的障碍和促进因素的看法。将评估每个诊所在30个月期间完成的实施活动的速度和数量。将进行经济分析，以确定CBHP在医疗系统中的预算影响和成本抵消情况。我们假设CBHP将有效减轻抑郁症状以及对慢性健康状况的溢出效应。我们还将研究种族/族裔少数群体患者之间的差异结果。
本研究将阐明成功实施CoCM的关键驱动因素。它将是首批对使用CoCM计费代码的按服务收费模式进行经济分析的研究之一。由于推广设计，数据可能为通过优化方法提高后续诊所的实施效率提供思路。讨论了方案的变更和研究的当前状态。
