ContextCare of patients with depression in managed primary care settings often fails to meet guideline standards, but the long-term impact quality improvement (QI) programs for such is unknown.ObjectiveTo determine if QI practices depressed improve care, health outcomes, and employment.DesignRandomized controlled trial initiated from June 1996 March 1997.SettingForty-six clinics 6 US organizations.ParticipantsOf 27,332 consecutively screened patients, 1356 current depressive symptoms either...

Background. Ethnic minority patients are less likely than white to receive guideline-concordant care for depression. It is uncertain whether racial and ethnic differences exist in patient beliefs, attitudes, preferences treatment. Methods. A telephone survey was conducted of 829 adult (659 non-Hispanic whites, 97 African Americans, 73 Hispanics) recruited from primary offices across the United States who reported 1 week or more depressed mood loss interest within past month met criteria...

This study aimed to determine the impact of teen depression on peer, family, school, and physical functioning burden parents.Patients participated in a longitudinal teens with without probable depression, drawn from 11 primary care offices Los Angeles, California, Washington, DC. A total 4856 completed full screening assessments; 4713 were eligible for study, 187 (4.0%) met criteria invited participate, as who not depressed. 184 baseline assessments nondepressed completed, 339 (90%) parent...

Depression is a leading cause of disability worldwide, but treatment rates in primary care are low.To determine the cost-effectiveness from societal perspective 2 quality improvement (QI) interventions to improve depression and their effects on patient employment.Group-level randomized controlled trial conducted June 1996 July 1999.Forty-six clinics 6 community-based managed organizations.One hundred eighty-one clinicians 1356 patients with positive screening results for current...

Community resilience, or the sustained ability of a community to withstand and recover from adversity, has become key policy issue. This report provides roadmap for federal, state, local leaders who are developing plans enhance resilience health security threats describes options building in areas.

Background: Depression is undertreated in primary care settings. Little research investigates the impact of patient involvement decisions on guideline-concordant treatment and depression outcomes. Objective: The objective this study was to determine whether decision-making associated with improvement symptoms. Design: Prospective cohort study. Setting: Multisite, nationwide randomized clinical trial quality strategies for care. Subjects: Primary patients current symptoms probable depressive...

The primary care (PC) setting provides a unique opportunity to address adolescent alcohol and other drug (AOD) use.We conducted randomized controlled trial in 4 PC clinics from April 2013 November 2015 determine whether 15-min brief motivational interviewing (MI) AOD intervention, delivered PC, reduced marijuana use consequences. Adolescents ages 12-18 who came for an appointment during the 2.5-year study period were asked be screened using National Institute of Alcohol Abuse Alcoholism...

This article addresses whether dissemination of short-term quality improvement (QI) interventions for depression to primary care practices improves patients' clinical outcomes and health-related life (HRQOL) over 2 years, relative usual (UC).The sample included 1299 patients with current depressive symptoms 12-month, lifetime, or no disorder from 46 in 6 managed organizations. Clinics were randomized UC 1 QI programs that training local experts nurse specialists provide clinician patient...

Objective. To examine the extent to which doctors' rational reactions clinical uncertainty (“statistical discrimination”) can explain racial differences in diagnosis of depression, hypertension, and diabetes. Data Sources. Main data are from Medical Outcomes Study (MOS), a 1986 study conducted by RAND Corporation three U.S. cities. The compares processes outcomes care for patients different health systems. Complementary National Health And Examination Survey III (NHANES III) Comorbidity...

This study builds on recent work describing African Americans' low trust in public health regarding terrorism preparedness by identifying the specific components of (fiduciary responsibility, honesty, competency, consistency, faith) that may influence community response to a bioterrorist attack. We used qualitative analysis data from 75 American adults living Los Angeles County who participated focus group discussions. Groups were stratified socioeconomic status (SES; up vs. above 200%...

This study sought to understand if shared decision making and/or receipt of mental health care was associated with patient satisfaction for patients depression and determine whether gender modified this relationship. The data are from the Quality Improvement Depression study, a national collaborative 1,481 diagnosed major in managed settings. cross-sectional analyses were performed using multiple logistic regression on sample 1,317 who answered both baseline month six questionnaires. Shared...

Adolescent depression is common, disabling, and associated with academic, social, behavioral, health consequences. Despite the availability of evidence-based care, few teens receive it, even when recognized by primary care clinicians. Perceived barriers such as teen worry about what others think or parent concerns cost access to may contribute low rates care. We sought better understand perceived their impact on service use.After completing an eligibility diagnostic telephone interview, all...

Despite recent efforts to increase access appropriate mental health care for veterans returning from conflicts in Iraq and Afghanistan, many challenges remain. These include veterans’ reluctance seek care, insufficient workforce capacity competency evidence-based practice, inadequate systems support improving care. broad must be addressed across the Veterans Health Administration, Department of Defense, community-based Policy reform will require federal leadership engage plans, professional...

Background: Daily clinical team meetings (i.e., “huddles”) may be helpful in implementing new roles and responsibilities for patient care because they provide a regular opportunity member learning feedback. Purposes: We examined how huddles were implemented the context of VA patient-centered medical home (PCMH) transformation, including assessing barriers facilitators to huddling among small teams (“teamlets”). assessed extent which teamlet members that huddled had higher self-efficacy PCMH...