Randomized Controlled Trial

. 2018 Sep 6;28(Suppl 2):325-338.

doi: 10.18865/ed.28.S2.325. eCollection 2018.

Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions

Benjamin Springgate¹, Lingqi Tang², Michael Ong³, Wayne Aoki⁴, Bowen Chung⁵, Elizabeth Dixon⁶, Megan Dwight Johnson⁷, Felica Jones⁸, Craig Landry², Elizabeth Lizaola², Norma Mtume⁹, Victoria K Ngo¹⁰, Esmeralda Pulido¹¹, Cathy Sherbourne¹², Aziza Lucas Wright¹³, Yolanda Whittington¹⁴, Pluscedia Williams¹⁵, Lily Zhang², Jeanne Miranda¹⁶, Thomas Belin¹⁷, James Gilmore¹⁸, Loretta Jones¹⁹, Kenneth B Wells²⁰

Affiliations

¹ Louisiana State University, Department of Medicine, School of Medicine, New Orleans, LA.
² Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA.
³ David Geffen School of Medicine at UCLA, Los Angeles CA.
⁴ Los Angeles Christian Health Centers, Los Angeles CA.
⁵ Los Angeles County Department of Mental Health Services, UCLA-Harbor General Hospital, David Geffen School of Medicine and Semel Institute at UCLA, RAND Health Program, Los Angeles CA.
⁶ School of Nursing, University of California, Los Angeles, Los Angeles CA.
⁷ Greater Los Angeles Veteran Affairs Health Care System, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles CA.
⁸ Healthy African American Families II, Los Angeles, CA.
⁹ Shields for Families, Los Angeles CA.
¹⁰ The RAND Corporation, Los Angeles CA.
¹¹ University of Washington Medical Center, Seattle, WA.
¹² The RAND Corporation, Santa Monica CA.
¹³ The RAND Corporation, Healthy African American Families II, New Vision Church of Jesus Christ, Los Angeles CA.
¹⁴ Los Angeles Department of Mental Health, Los Angeles CA.
¹⁵ Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles, CA.
¹⁶ Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles CA.
¹⁷ Department of Biostatistics, Fielding School of Public Health, South Los Angeles CA.
¹⁸ Behavioral Health Services, Gardena, CA.
¹⁹ Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles CA.
²⁰ Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health at UCLA; RAND Health Program, Los Angeles CA.

PMID: 30202185
PMCID: PMC6128327
DOI: 10.18865/ed.28.S2.325

Randomized Controlled Trial

Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions

Benjamin Springgate et al. Ethn Dis. 2018.

. 2018 Sep 6;28(Suppl 2):325-338.

doi: 10.18865/ed.28.S2.325. eCollection 2018.

Authors

Affiliations

¹ Louisiana State University, Department of Medicine, School of Medicine, New Orleans, LA.
² Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA.
³ David Geffen School of Medicine at UCLA, Los Angeles CA.
⁴ Los Angeles Christian Health Centers, Los Angeles CA.
⁵ Los Angeles County Department of Mental Health Services, UCLA-Harbor General Hospital, David Geffen School of Medicine and Semel Institute at UCLA, RAND Health Program, Los Angeles CA.
⁶ School of Nursing, University of California, Los Angeles, Los Angeles CA.
⁷ Greater Los Angeles Veteran Affairs Health Care System, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles CA.
⁸ Healthy African American Families II, Los Angeles, CA.
⁹ Shields for Families, Los Angeles CA.
¹⁰ The RAND Corporation, Los Angeles CA.
¹¹ University of Washington Medical Center, Seattle, WA.
¹² The RAND Corporation, Santa Monica CA.
¹³ The RAND Corporation, Healthy African American Families II, New Vision Church of Jesus Christ, Los Angeles CA.
¹⁴ Los Angeles Department of Mental Health, Los Angeles CA.
¹⁵ Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles, CA.
¹⁶ Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles CA.
¹⁷ Department of Biostatistics, Fielding School of Public Health, South Los Angeles CA.
¹⁸ Behavioral Health Services, Gardena, CA.
¹⁹ Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles CA.
²⁰ Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health at UCLA; RAND Health Program, Los Angeles CA.

PMID: 30202185
PMCID: PMC6128327
DOI: 10.18865/ed.28.S2.325

Abstract

Significance: Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Resources for Services (RS) for program technical assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical conditions (MCC) are unknown.

Objective: To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups.

Design: Secondary analyses of a cluster-randomized trial.

Setting: 93 health care and community-based programs in two neighborhoods.

Participants: Of 4,440 clients screened, 1,322 depressed (Patient Health Questionnaire, PHQ8) provided contact information, 1,246 enrolled and 1,018 (548 with ≥3 MCC) completed baseline, 6- or 12-month surveys.

Intervention: CEP or RS for implementing depression quality improvement programs.

Outcomes and analyses: Primary: depression (PHQ9 <10), poor MHRQL (Short Form Health Survey, SF-12<40); Secondary: mental wellness, good physical health, behavioral health hospitalization, chronic homelessness risk, work/workloss days, services use at 6 and 12 months. End-point regressions were used to estimate intervention effects on outcomes for subgroups with ≥3 MCC, non-MCC, and intervention-by-MCC interactions (exploratory).

Results: Among MCC clients at 6 months, CEP vs RS lowered likelihoods of depression and poor MHRQL; increased likelihood of mental wellness; reduced work-loss days among employed and likelihoods of ≥4 behavioral-health hospitalization nights and chronic homelessness risk, while increasing faith-based and park community center depression services; and at 12 months, likelihood of good physical health and park community center depression services use (each P<.05). There were no significant interactions or primary outcome effects for non-MCC.

Conclusions: CEP was more effective than RS in improving 6-month primary outcomes among depressed MCC clients, without significant interactions.

Keywords: Chronic Conditions; Coalition Intervention; Depression; Quality Improvement.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: None declared.

References

1. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617-627. 10.1001/archpsyc.62.6.61710.1001/archpsyc.62.6.617 - DOI - DOI - PMC - PubMed
1. Unützer J, Park M. Strategies to improve the management of depression in primary care. Prim Care. 2012;39(2):415-431. 10.1016/j.pop.2012.03.010 - DOI - PMC - PubMed
1. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007;370(9590):851-858. 10.1016/S0140-6736(07)61415-9 - DOI - PubMed
1. Druss BG, Rosenheck RA. Patterns of health care costs associated with depression and substance abuse in a national sample. Psychiatr Serv. 1999;50(2):214-218. 10.1176/ps.50.2.214 - DOI - PubMed
1. Druss BG, Rosenheck RA, Sledge WH. Health and disability costs of depressive illness in a major U.S. corporation. Am J Psychiatry. 2000;157(8):1274-1278. 10.1176/appi.ajp.157.8.1274 - DOI - PubMed

Publication types

Actions
Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- ClinicalTrials.gov
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions

Affiliations

Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical