Cost-effectiveness of practice-initiated quality improvement for depression -: Results of a randomized controlled trial

被引:256
作者
Schoenbaum, M
Unützer, J
Sherbourne, C
Duan, NH
Rubenstein, LV
Miranda, J
Meredith, LS
Carney, MF
Wells, K
机构
[1] RAND Corp, Hlth Program, Arlington, VA 22202 USA
[2] RAND Corp, Hlth Program, Santa Monica, CA USA
[3] Univ Calif Los Angeles, Inst Neuropsychiat, Los Angeles, CA 90024 USA
[4] Sepulveda VA Med Ctr, HSR&D Ctr Excellence Study Healthcare Provider Be, Sepulveda, CA USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2001年 / 286卷 / 11期
关键词
D O I
10.1001/jama.286.11.1325
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Depression is a leading cause of disability worldwide, but treatment rates in primary care are low. Objective To determine the cost-effectiveness from a societal perspective of 2 quality improvement (QI) interventions to improve treatment of depression in primary care and their effects on patient employment. Design Group-level randomized controlled trial conducted June 1996 to July 1999. Setting Forty-six primary care clinics in 6-community-based managed care organizations. Participants One hundred eighty-one primary care clinicians and 1356 patients with positive screening results for current depression. Interventions Matched practices were randomly assigned to provide usual care (n=443 patients) or to 1 of 2 QI interventions offering training to practice leaders and nurses, enhanced educational and assessment resources, and either nurses for medication follow-up (QI-meds; n=424 patients) or trained local psychotherapists (QI-therapy; n=489). Practices could flexibly implement the interventions, which did not assign type of treatment. Main Outcome Measures Total health care costs, costs per quality-adjusted life-year (QALY), days with depression burden, and employment over 24 months, compared between usual care and the 2 interventions. Results Relative to usual care, average health care costs increased $419 (11%) in QI-meds (P=.35) and $485 (13%) in QI-therapy (P=.28); estimated costs per QALY gained were between $15331 and $36467 for QI-meds and $9478 and $21478 for QI-therapy; and patients had 25 (P=.19) and 47 (P=.01) fewer days with depression burden and were employed 17.9 (P=.07) and 20.9 (P=.03) more days during the study period. Conclusions Societal cost-effectiveness of practice-initiated QI efforts for depression is comparable with that of accepted medical interventions. The intervention effects on employment may be of particular interest to employers and other stakeholders.
引用
收藏
页码:1325 / 1330
页数:6
相关论文
共 43 条
  • [1] [Anonymous], 1996, Caring for depression
  • [3] Duan N., 1983, J EC BUSINESS STATIS, V1, P115, DOI [DOI 10.2307/1391852, DOI 10.1080/07350015.1983.10509330]
  • [4] THE BEAVER DAM HEALTH OUTCOMES STUDY - INITIAL CATALOG OF HEALTH-STATE QUALITY FACTORS
    FRYBACK, DG
    DASBACH, EJ
    KLEIN, R
    KLEIN, BEK
    DORN, N
    PETERSON, K
    MARTIN, PA
    [J]. MEDICAL DECISION MAKING, 1993, 13 (02) : 89 - 102
  • [5] Gold MR, 1996, COST EFFECTIVENESS H
  • [6] Henk HJ, 1996, ARCH GEN PSYCHIAT, V53, P899
  • [7] Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care
    Hunkeler, EM
    Meresman, JF
    Hargreaves, WA
    Fireman, B
    Berman, WH
    Kirsch, AJ
    Groebe, J
    Hurt, SW
    Braden, P
    Getzell, M
    Feigenbaum, PA
    Peng, T
    Salzer, M
    [J]. ARCHIVES OF FAMILY MEDICINE, 2000, 9 (08) : 700 - 708
  • [8] EPIDEMIOLOGY OF DEPRESSION IN PRIMARY CARE
    KATON, W
    SCHULBERG, H
    [J]. GENERAL HOSPITAL PSYCHIATRY, 1992, 14 (04) : 237 - 247
  • [9] Katon W, 1996, ARCH GEN PSYCHIAT, V53, P924
  • [10] COLLABORATIVE MANAGEMENT TO ACHIEVE TREATMENT GUIDELINES - IMPACT ON DEPRESSION IN PRIMARY-CARE
    KATON, W
    VONKORFF, M
    LIN, E
    WALKER, E
    SIMON, GE
    BUSH, T
    ROBINSON, P
    RUSSO, J
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1995, 273 (13): : 1026 - 1031