TY - JOUR
T1 - Controlled trials of CQI and academic detailing to implement a clinical practice guideline for depression
AU - Brown, Jonathan Betz
AU - Shye, Diana
AU - McFarland, Bentson H.
AU - Nichols, Gregory A.
AU - Mullooly, John P.
AU - Johnson, Richard E.
N1 - Funding Information:
This work was supported by the U.S. Agency for Health Care Policy and Research , under cooperative agreement U01HS07649 , and by Kaiser Permanente Northwest Division. Particular thanks are due to our project officers at AHCPR, David Lanier and Morgan Jackson; Harold Goldberg, principle investigator of a parallel study in Seattle, with whom we worked closely; Steven Soumerai, who advised on the AD intervention and trial; Suzanne Gauen and Collette Yamaguchi, who helped develop and/or managed the AD training and intervention; Henry Betz-Brown and Gary Larson for contributions of artwork; Margaret Porter McClure, Margaret Vandenbark, Scott Dunlap, Norm Muilenberg, and the other members of the guideline translation and CQI teams; and several senior KPNW leaders who sponsored and facilitated aspects of the work—Terry Carr, Marna Flaherty-Robb, Nancy Louis-Lee, Mark Leveaux, Nan Robertson, Tom Syltebo, Allan Weiland, Bill Wojeski, and Lauretta Young.
PY - 2000/1
Y1 - 2000/1
N2 - BACKGROUND: The release of the Agency for Health Care Policy and Research (AHCPR)'s Guideline for the Detection and Treatment of Depression in Primary Care created an opportunity to evaluate under naturalistic conditions the effectiveness of two clinical practice guideline implementation methods: continuous quality improvement (CQI) and academic detailing. A study conducted in 1993-1994 at Kaiser Permanente Northwest Division, a large, not-for-profit prepaid group practice (group-model) HMO, tested the hypotheses that each method would increase the number of members receiving depression treatment and would relieve depressive symptoms. METHODS: Two trials were conducted simultaneously among adult primary care physicians, physician assistants, and nurse practitioners, using the same guideline document, measurement methods, and one-year follow-up period. The academic detailing trial was randomized at the clinician level. CQI was assigned to one of the setting's two geographic areas. To account for intraclinician correlation, both trials were evaluated using generalized equations analysis. RESULTS: Most of the CQI team's recommendations were not implemented. Academic detailing increased treatment rates, but--in a cohort of patients with probable chronic depressive disorder--it failed to improve symptoms and reduced measures of overall functional status. CONCLUSIONS: New organizational structures may be necessary before CQI teams and academic detailing can substantially change complex processes such as the primary care of depression. New research and treatment guidelines are needed to improve the management of persons with chronic or recurring major depressive disorder.
AB - BACKGROUND: The release of the Agency for Health Care Policy and Research (AHCPR)'s Guideline for the Detection and Treatment of Depression in Primary Care created an opportunity to evaluate under naturalistic conditions the effectiveness of two clinical practice guideline implementation methods: continuous quality improvement (CQI) and academic detailing. A study conducted in 1993-1994 at Kaiser Permanente Northwest Division, a large, not-for-profit prepaid group practice (group-model) HMO, tested the hypotheses that each method would increase the number of members receiving depression treatment and would relieve depressive symptoms. METHODS: Two trials were conducted simultaneously among adult primary care physicians, physician assistants, and nurse practitioners, using the same guideline document, measurement methods, and one-year follow-up period. The academic detailing trial was randomized at the clinician level. CQI was assigned to one of the setting's two geographic areas. To account for intraclinician correlation, both trials were evaluated using generalized equations analysis. RESULTS: Most of the CQI team's recommendations were not implemented. Academic detailing increased treatment rates, but--in a cohort of patients with probable chronic depressive disorder--it failed to improve symptoms and reduced measures of overall functional status. CONCLUSIONS: New organizational structures may be necessary before CQI teams and academic detailing can substantially change complex processes such as the primary care of depression. New research and treatment guidelines are needed to improve the management of persons with chronic or recurring major depressive disorder.
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U2 - 10.1016/S1070-3241(00)26004-5
DO - 10.1016/S1070-3241(00)26004-5
M3 - Article
C2 - 10677821
AN - SCOPUS:0033627592
SN - 1070-3241
VL - 26
SP - 39
EP - 54
JO - The Joint Commission journal on quality improvement
JF - The Joint Commission journal on quality improvement
IS - 1
ER -