BACKGROUND: Meta-analyses show collaborative care models (CCMs) with nurse care management are effective for improving primary care for @entity308 . This study aimed to develop @entity5380 approaches that could be sustained and spread within Veterans Affairs (VA). Evidence-based quality improvement (EBQI) uses QI approaches within a research/clinical partnership to redesign care. The study used EBQI methods for @entity5380 redesign, tested the effectiveness of the locally adapted model as implemented, and assessed the contextual factors shaping intervention effectiveness. METHODS: The study intervention is EBQI as applied to @entity5380 implementation. The study uses a cluster randomized design as a formative evaluation tool to test and improve the effectiveness of the redesign process, with seven intervention and three non-intervention VA primary care practices in five different states. The primary study outcome is patient antidepressant use. The context evaluation is descriptive and uses subgroup analysis. The primary context evaluation measure is naturalistic primary care clinician (PCC) predilection to adopt @entity5380 .For the randomized evaluation, trained telephone research interviewers enrolled consecutive primary care @entity1 with @entity308 in the evaluation, referred enrolled @entity1 in intervention practices to the implemented @entity5380 , and re-surveyed at seven months. RESULTS: Interviewers enrolled 288 @entity5380 site and 258 non- @entity5380 site @entity1 . Enrolled intervention site @entity1 were more likely to receive appropriate antidepressant care (66% versus 43%, p = 0.01), but showed no significant difference in symptom improvement compared to usual care. In terms of context, only 40% of enrolled @entity1 received complete care management per protocol. PCC predilection to adopt @entity5380 had substantial effects on @entity1 participation, with @entity1 belonging to early adopter clinicians completing adequate care manager follow-up significantly more often than @entity1 of clinicians with low predilection to adopt @entity5380 (74% versus 48%%, p = 0.003). CONCLUSIONS: @entity308 designed and implemented by primary care practices using EBQI improved antidepressant initiation. Combining QI methods with a randomized evaluation proved challenging, but enabled new insights into the process of translating research-based @entity5380 into practice. Future research on the effects of PCC attitudes and skills on @entity5380 results, as well as on enhancing the link between improved antidepressant use and symptom outcomes, is needed. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00105820.

Implementing collaborative care for XXXX treatment in primary care: a cluster randomized evaluation of a quality improvement practice redesign.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity5380 :: ('MESH:D020786', 'Disease') :: ['CCM'] @entity308 :: ('MESH:D003866', 'Disease') :: ['depression', 'major depression', 'Depression CCM']
@entity308 :: (MESH:D003866,Disease) :: ['depression']
