A CQI Intervention To Change the Care of Depression: A Controlled Study

CONTEXT. Although new strategies for managing depression in primary care (e.g., nurse telephone calls, collaborative care) have been shown to be effective, no models are available for their systematic implementation in the “real world.” OBJECTIVE. To test whether a continuous quality improvement (CQI) intervention could be used to implement systems in primary care clinics to improve the care and outcomes for patients diagnosed with depression. DESIGN. Before–after study with concurrent controls. INTERVENTION. A multidisciplinary team from the three intervention clinics devel-oped and implemented a graded set of five care management options, ranging from watchful waiting (nurse telephone call in 4 to 6 weeks) to mental health manage-ment, which clinicians could order for their patients with depression. SETTING. 9 primary care clinics in greater Minneapolis–St. Paul, Minnesota. PATIENTS. Outpatients 18 years of age and older whose primary care clinic visit includ-ed an International Classification of Diseases, 9th revision, code for depression and who completed baseline and 3-month follow-up surveys before and after the intervention