Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions

Benjamin Springgate; Lingqi Tang; Michael Ong; Wayne Aoki; Bowen Chung; Elizabeth Dixon; Megan Dwight Johnson; Felica Jones; Craig Landry; Elizabeth Lizaola; Norma Mtume; Victoria K Ngo; Esmeralda Pulido; Cathy Sherbourne; Aziza Lucas Wright; Yolanda Whittington; Pluscedia Williams; Lily Zhang; Jeanne Miranda; Thomas Belin; James Gilmore; Loretta Jones; Kenneth B Wells

doi:10.18865/ed.28.S2.325

Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions

Ethn Dis. 2018 Sep 6;28(Suppl 2):325-338. doi: 10.18865/ed.28.S2.325. eCollection 2018.

Authors

Benjamin Springgate¹, Lingqi Tang², Michael Ong³, Wayne Aoki⁴, Bowen Chung⁵, Elizabeth Dixon⁶, Megan Dwight Johnson⁷, Felica Jones⁸, Craig Landry², Elizabeth Lizaola², Norma Mtume⁹, Victoria K Ngo¹⁰, Esmeralda Pulido¹¹, Cathy Sherbourne¹², Aziza Lucas Wright¹³, Yolanda Whittington¹⁴, Pluscedia Williams¹⁵, Lily Zhang², Jeanne Miranda¹⁶, Thomas Belin¹⁷, James Gilmore¹⁸, Loretta Jones¹⁹, Kenneth B Wells²⁰

Affiliations

¹ Louisiana State University, Department of Medicine, School of Medicine, New Orleans, LA.
² Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA.
³ David Geffen School of Medicine at UCLA, Los Angeles CA.
⁴ Los Angeles Christian Health Centers, Los Angeles CA.
⁵ Los Angeles County Department of Mental Health Services, UCLA-Harbor General Hospital, David Geffen School of Medicine and Semel Institute at UCLA, RAND Health Program, Los Angeles CA.
⁶ School of Nursing, University of California, Los Angeles, Los Angeles CA.
⁷ Greater Los Angeles Veteran Affairs Health Care System, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles CA.
⁸ Healthy African American Families II, Los Angeles, CA.
⁹ Shields for Families, Los Angeles CA.
¹⁰ The RAND Corporation, Los Angeles CA.
¹¹ University of Washington Medical Center, Seattle, WA.
¹² The RAND Corporation, Santa Monica CA.
¹³ The RAND Corporation, Healthy African American Families II, New Vision Church of Jesus Christ, Los Angeles CA.
¹⁴ Los Angeles Department of Mental Health, Los Angeles CA.
¹⁵ Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles, CA.
¹⁶ Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles CA.
¹⁷ Department of Biostatistics, Fielding School of Public Health, South Los Angeles CA.
¹⁸ Behavioral Health Services, Gardena, CA.
¹⁹ Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles CA.
²⁰ Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health at UCLA; RAND Health Program, Los Angeles CA.

Abstract

Significance: Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Resources for Services (RS) for program technical assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical conditions (MCC) are unknown.

Objective: To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups.

Design: Secondary analyses of a cluster-randomized trial.

Setting: 93 health care and community-based programs in two neighborhoods.

Participants: Of 4,440 clients screened, 1,322 depressed (Patient Health Questionnaire, PHQ8) provided contact information, 1,246 enrolled and 1,018 (548 with ≥3 MCC) completed baseline, 6- or 12-month surveys.

Intervention: CEP or RS for implementing depression quality improvement programs.

Outcomes and analyses: Primary: depression (PHQ9 <10), poor MHRQL (Short Form Health Survey, SF-12<40); Secondary: mental wellness, good physical health, behavioral health hospitalization, chronic homelessness risk, work/workloss days, services use at 6 and 12 months. End-point regressions were used to estimate intervention effects on outcomes for subgroups with ≥3 MCC, non-MCC, and intervention-by-MCC interactions (exploratory).

Results: Among MCC clients at 6 months, CEP vs RS lowered likelihoods of depression and poor MHRQL; increased likelihood of mental wellness; reduced work-loss days among employed and likelihoods of ≥4 behavioral-health hospitalization nights and chronic homelessness risk, while increasing faith-based and park community center depression services; and at 12 months, likelihood of good physical health and park community center depression services use (each P<.05). There were no significant interactions or primary outcome effects for non-MCC.

Conclusions: CEP was more effective than RS in improving 6-month primary outcomes among depressed MCC clients, without significant interactions.

Keywords: Chronic Conditions; Coalition Intervention; Depression; Quality Improvement.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cluster Analysis
Community Mental Health Services* / methods
Community Mental Health Services* / standards
Community Participation / methods*
Depression* / physiopathology
Depression* / rehabilitation
Female
Health Planning Technical Assistance / organization & administration
Humans
Male
Mental Health
Middle Aged
Multiple Chronic Conditions* / psychology
Multiple Chronic Conditions* / rehabilitation
Psychosocial Support Systems
Quality Improvement
Quality of Life*

Abstract

Publication types

MeSH terms

Grants and funding