Organizational Cost of Quality Improvement for Depression Care

Authors

  • Chuan-Fen Liu,

    1. Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Healthcare System, 1100 Olive Way, Suite 1400, Seattle, WA 98101,
    2. Department of Health Services, School of Public Health and Community Medicine, University of Washington Seattle, WA,
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    • Address correspondence to Chuan-Fen Liu, Ph.D., Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Healthcare System, 1100 Olive Way, Suite 1400, Seattle, WA 98101. e-mail: chuan-fen.liu@va.gov. Chuan-Fen Liu, Ph.D., is also with the Department of Health Services, School of Public Health and Community Medicine, University of Washington Seattle, WA. Lisa V. Rubenstein, M.D., is with the Center of Excellence for the Study for Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, Sepulveda, CA, and also with the RAND Health Program, Santa Monica, CA, and the Department of Medicine, University of California Los Angeles, Los Angeles, CA. JoAnn E. Kirchner, M.D., John C. Fortney, Ph.D., and Jeffrey M. Pyne, M.D., are with the South Central Mental Health Illness Research and Education and Clinical Center, North Little Rock, AR, and also with the Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, and the Division of Health Service Research, Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR. Mark W. Perkins, Pharm.D., and Edmund F. Chaney, Ph.D., are with the Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Healthcare System, Seattle, WA. Scott K. Ober, M.D., is with the Cleveland VA Medical Center, Cleveland, OH, and also with the Department of Medicine, Case Western Reserve University, Cleveland, OH. Edmund F. Chaney, Ph.D., is also with the Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA.

  • Lisa V. Rubenstein,

    1. Center of Excellence for the Study for Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, Sepulveda, CA,
    2. RAND Health Program, Santa Monica, CA,
    3. Department of Medicine, University of California Los Angeles, Los Angeles, CA,
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  • JoAnn E. Kirchner,

    1. South Central Mental Health Illness Research and Education and Clinical Center, North Little Rock, AR,
    2. Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR,
    3. ,
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  • John C. Fortney,

    1. South Central Mental Health Illness Research and Education and Clinical Center, North Little Rock, AR,
    2. Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR,
    3. ,
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  • Mark W. Perkins,

    1. Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Healthcare System, Seattle, WA,
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  • Scott K. Ober,

    1. Cleveland VA Medical Center, Cleveland, OH,
    2. Department of Medicine, Case Western Reserve University, Cleveland, OH,
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  • Jeffrey M. Pyne,

    1. South Central Mental Health Illness Research and Education and Clinical Center, North Little Rock, AR,
    2. Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR,
    3. ,
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  • Edmund F. Chaney

    1. Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Healthcare System, Seattle, WA,
    2. Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA
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Abstract

Objective. We documented organizational costs for depression care quality improvement (QI) to develop an evidence-based, Veterans Health Administration (VA) adapted depression care model for primary care practices that performed well for patients, was sustained over time, and could be spread nationally in VA.

Data Sources and Study Setting. Project records and surveys from three multistate VA administrative regions and seven of their primary care practices.

Study Design. Descriptive analysis.

Data Collection. We documented project time commitments and expenses for 86 clinical QI and 42 technical expert support team participants for 4 years from initial contact through care model design, Plan–Do–Study–Act cycles, and achievement of stable workloads in which models functioned as routine care. We assessed time, salary costs, and costs for conference calls, meetings, e-mails, and other activities.

Principle Findings. Over an average of 27 months, all clinics began referring patients to care managers. Clinical participants spent 1,086 hours at a cost of $84,438. Technical experts spent 2,147 hours costing $197,787. Eighty-five percent of costs derived from initial regional engagement activities and care model design.

Conclusions. Organizational costs of the QI process for depression care in a large health care system were significant, and should be accounted for when planning for implementation of evidence-based depression care.

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