The Learning Curve After Implementation of Collaborative Care in a State Mental Health Integration Program.
OBJECTIVE
This study examined organizational variability of process-of-care and depression outcomes at eight community health centers (CHCs) in the years following implementation of collaborative care (CC) for depression.


METHODS
The authors used 8 years of observational data for 13,362 unique patients at eight CHCs that participated in Washington State's Mental Health Integration Program. Organization-level changes in depression and process-of-care outcomes over time were studied.


RESULTS
On average, depression outcomes improved for the first 2 years before improvement slowed, peaking at year 5. Significant organization-level variation was noted in outcomes. Improvements in depression outcomes tended to follow process-of-care measures.


CONCLUSIONS
Findings suggest that it may take 2 years after implementation of CC to fully observe depression outcome improvement at an organization level. Substantial variation between organizations in depression outcomes over time suggests that sustained attention to processes of care may be necessary to maintain initially achieved gains.
['Carlo|Andrew D|AD|', 'Jeng|Philip J|PJ|', 'Bao|Yuhua|Y|', 'Unützer|Jürgen|J|']
D000328:Adult D003153:Community Health Services D019033:Delivery of Health Care, Integrated D003866:Depressive Disorder D006302:Health Services Research D006801:Humans D059032:Learning Curve D008605:Mental Health Services D010043:Outcome and Process Assessment, Health Care D011320:Primary Health Care D014861:Washington
Behavioral Health Integration Behavioral medicine Integrated Care Organizational Learning Primary Care Psychiatry Psychosomatic medicine