Marcia Valenstein, MD, MS Tamara Ritsema, MPH Lee Green, MD, MPH Frederic C. Blow, PhD Allison Mitchinson, MPH John F. McCarthy, MPH Kristen Lawton Barry, PhD Elizabeth Hill, PhD Ann Arbor and Detroit, Michigan Submitted, revised, March 1, 2000. From the Serious Mental Illness Treatment Research and Evaluation Center, Health Services Research and Development, Department of Veterans Affairs Medical Center, Ann Arbor (M.V., F.C.B., A.M., J.F.M., K.L.B.); Psychiatry Service, Veterans Affairs Medical Center, Ann Arbor (M.V.); the departments of Family Practice (T.R., L.G.) and Psychiatry (M.V., T.R., F.C.B., K.L.B.), University of Michigan, Ann Arbor; and the Department of Psychology, University of Detroit Mercy, Detroit (E.H.). Reprint requests should be addressed to Marcia Valenstein, MD, MS, SMITREC, Health Services Research and Development, P.O. Box 130170, Ann Arbor, MI 48113-0170. E
References
Since QI programs will often need to secure PCP permission and patient cooperation if they are to monitor patients’ clinical status, they are likely to face many of the same selection pressures that potentially affected our results. They are also likely to experience similar variation in the timing of patients’ completion and return of any mailed assessments. The enrollment rate in our study is similar to that of many QI projects in primary care. Thus, our data remain germane to QI programs that are considering targeting this population.
Conclusions
Health care organizations using administrative data to identify primary care patients with depression for QI activities are likely to select a cohort that is significantly ill, has had previous trials of psychotherapy, and is currently receiving antidepressants. Most patients will improve, yet many will continue to have significant symptoms. For QI efforts to have a significant impact on this population, they may need to offer intensive alternatives, such as disease management programs, intensive monitoring of patient adherence, or stepped care, rather than simply monitoring the provision of standard treatments.
Acknowledgments
Funding for this research was provided by the Office of Clinical Affairs, University of Michigan, and the Department of Veterans Affairs, HSR&D Research Career Development Award, RC-98350-1. We would like to thank the primary care providers in the BWO and CFC clinics for their assistance in this study. They would also like to thank Sharon Blanchard for data support. The study protocol was approved by the University of Michigan Institutional Review Board and by research committees at the study clinics.
