Expanding and Testing VA Collaborative Care Models for Depression

Not Applicable

Withdrawn

• Conditions: Major Depression; Post-Traumatic Stress Disorder
• Interventions: Procedure: Depression Care Quality Improvement Implementation

• Registration Number: NCT00119028
• Lead Sponsor: US Department of Veterans Affairs

Brief Summary

Based on the published evidence, collaborative care for depression is both necessary and sufficient for improving care and outcomes for depressed patients in primary care settings. The Translating Initiatives in Depression into Effective Solutions (TIDES) project, upon which ReTIDES is based, developed a VA-adapted version of collaborative care through input from veterans, clinicians, and managers. The initial TIDES project resulted in a clinically stable and effective model as tested in seven primary care practices in three VISNs. This positive result provided the basis for spreading and sustaining the TIDES model and initiating the study of national implementation strategies and issues.

Detailed Description

Background:

Based on the published evidence, collaborative care for depression is both necessary and sufficient for improving care and outcomes for depressed patients in primary care settings. The Translating Initiatives in Depression into Effective Solutions (TIDES) project, upon which ReTIDES is based, developed a VA-adapted version of collaborative care through input from veterans, clinicians, and managers. The initial TIDES project resulted in a clinically stable and effective model as tested in seven primary care practices in three VISNs. This positive result provided the basis for spreading and sustaining the TIDES model and initiating the study of national implementation strategies and issues.

Objectives:

The objective of this grant was to carry out preparatory steps toward national implementation, including developing and investigating TIDES sustainability and partnering and marketing strategies. The project supported VISNs as learning organizations in the area of depression care improvement, and ultimately aimed to support as many as 8% to 10% of veterans nationally in improving their health and quality of life. Preparatory steps included 1) development of easily disseminated tools, including CPRS decision support, panel monitoring, and care manager and team training materials, 2) national and local dissemination to support TIDES model sustainability and spread and 3) evaluation using tools that would assess not only the success of this project, but could be used for quality monitoring during roll-out.

Methods:

Tools: We used the Chronic Illness Care model and Evidence Based Quality Improvement methods to develop tools for disseminating TIDES to additional medical centers and practices in 3 TIDES VISNs and two medical centers (with 10 practices) in one additional VISN. These tools were then used for national implementation. Dissemination: We served as technical expert consultants by 1) carrying out national and regional training; 2) linking to national patient care services, employee education, and information technology methods and priorities; and 3) supporting evidence-based quality improvement in new sites.We organized these efforts through a national dissemination plan.

Evaluation: We developed and applied 1) formative evaluation tools; 2) fine-tuned performance measure tools based on electronic data, and applied in a non-randomized quasi-experimental design (untreated control group with pretest and posttest); 3) a web-based survey for primary care clinicians and 4) an innovative implementation cost assessment approach. We also used 5) qualitative information on the process of dissemination , including links to national resources and 6) a randomized design to evaluate long term (18-month) cost effectiveness of TIDES.

Status:

Completed.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study Start: 2005-04
• Study First Submitted: 2005-07-01
• Study First Submitted QC: 2005-07-11
• Study First Posted: 2005-07-12
• Primary Completion: 2008-12
• Study Completion: 2009-10
• Status Verified: 2012-04
• Last Update Submitted: 2012-04-23
• Last Update Posted: 2012-04-24

Recruitment & Eligibility

• Status: WITHDRAWN
• Sex: All
• Target Recruitment: Not specified

Inclusion Criteria

• Primary care providers at each participating site.

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Exclusion Criteria

• All providers not located at participating sites.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm 1	Depression Care Quality Improvement Implementation	Non-experimental QI intervention - No comparator

Primary Outcome Measures

Name	Time	Method
Impact of the intervention on depression performance measure, and provider attitudes. Quality of life-patient satisfaction.	9/30/08

Secondary Outcome Measures

Name	Time	Method
Cost-effectiveness, system costs, tool kit development	9/30/08

Trial Locations

Locations (5)

St. Cloud VA Medical Center; 🇺🇸 St Cloud, Minnesota, United States

VA Medical Center, Cincinnati; 🇺🇸 Cincinnati, Ohio, United States

Long Beach; 🇺🇸 Long Beach, California, United States

Michael E DeBakey VA Medical Center; 🇺🇸 Houston, Texas, United States

VA Medical Center; 🇺🇸 Minneapolis, Minnesota, United States