Controlled trials of CQI and academic detailing to implement a clinical practice guideline for depression.

J. B. Brown, D. Shye, Bentson McFarland, G. A. Nichols, J. P. Mullooly, R. E. Johnson

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)39-54
Number of pages16
JournalThe Joint Commission Journal on Quality Improvement
Volume26
Issue number1
StatePublished - 2000

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Quality Improvement
Practice Guidelines
Depression
Guidelines
Primary Health Care
Prepaid Group Practice
United States Agency for Healthcare Research and Quality
Physician Assistants
Nurse Practitioners
Health Maintenance Organizations
Major Depressive Disorder
Primary Care Physicians
Therapeutics
Depressive Disorder
Research

Cite this

Brown, J. B., Shye, D., McFarland, B., Nichols, G. A., Mullooly, J. P., & Johnson, R. E. (2000). Controlled trials of CQI and academic detailing to implement a clinical practice guideline for depression. The Joint Commission Journal on Quality Improvement, 26(1), 39-54.

Controlled trials of CQI and academic detailing to implement a clinical practice guideline for depression. / Brown, J. B.; Shye, D.; McFarland, Bentson; Nichols, G. A.; Mullooly, J. P.; Johnson, R. E.

In: The Joint Commission Journal on Quality Improvement, Vol. 26, No. 1, 2000, p. 39-54.

Research output: Contribution to journalArticle

Brown, JB, Shye, D, McFarland, B, Nichols, GA, Mullooly, JP & Johnson, RE 2000, 'Controlled trials of CQI and academic detailing to implement a clinical practice guideline for depression.', The Joint Commission Journal on Quality Improvement, vol. 26, no. 1, pp. 39-54.
Brown, J. B. ; Shye, D. ; McFarland, Bentson ; Nichols, G. A. ; Mullooly, J. P. ; Johnson, R. E. / Controlled trials of CQI and academic detailing to implement a clinical practice guideline for depression. In: The Joint Commission Journal on Quality Improvement. 2000 ; Vol. 26, No. 1. pp. 39-54.
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