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Titolo:
Cost-effectiveness of practice-initiated quality improvement for depression - Results of a randomized controlled trial
Autore:
Schoenbaum, M; Unutzer, J; Sherbourne, C; Duan, NH; Rubenstein, LV; Miranda, J; Meredith, LS; Carney, MF; Wells, K;
Indirizzi:
RAND Corp, Hlth Program, Arlington, VA 22202 USA RAND Corp Arlington VA USA 22202 p, Hlth Program, Arlington, VA 22202 USA RAND Corp, Hlth Program, Santa Monica, CA USA RAND Corp Santa Monica CA USA D Corp, Hlth Program, Santa Monica, CA USA Univ Calif Los Angeles, Inst Neuropsychiat, Los Angeles, CA 90024 USA UnivCalif Los Angeles Los Angeles CA USA 90024 Los Angeles, CA 90024 USA Sepulveda VA Med Ctr, HSR&D Ctr Excellence Study Healthcare Provider Be, Sepulveda, CA USA Sepulveda VA Med Ctr Sepulveda CA USA are Provider Be, Sepulveda, CA USA
Titolo Testata:
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
fascicolo: 11, volume: 286, anno: 2001,
pagine: 1325 - 1330
SICI:
0098-7484(20010919)286:11<1325:COPQIF>2.0.ZU;2-U
Fonte:
ISI
Lingua:
ENG
Soggetto:
PRIMARY-CARE PRACTICES; MANAGED PRIMARY-CARE; MAJOR DEPRESSION; HEALTH; OUTCOMES; UTILITIES; IMPACT; SF-12; LIFE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
43
Recensione:
Indirizzi per estratti:
Indirizzo: Schoenbaum, M RAND Corp, Hlth Program, 1200 S Hayes St, Arlington, VA 22202 USA RAND Corp 1200 S Hayes St Arlington VA USA 22202 A 22202 USA
Citazione:
M. Schoenbaum et al., "Cost-effectiveness of practice-initiated quality improvement for depression - Results of a randomized controlled trial", J AM MED A, 286(11), 2001, pp. 1325-1330

Abstract

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 July1999. 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, andeither 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.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 25/11/20 alle ore 07:08:43