Preventing Chronic Disease | Collaborative Depression Care Among Latino Patients in Diabetes Disease Management, Los Angeles, 2011–2013 - CDC
Collaborative Depression Care Among Latino Patients in Diabetes Disease Management, Los Angeles, 2011–2013
Brian Wu, BS; Haomiao Jin, MS; Irene Vidyanti, MEng; Pey-Jiuan Lee, MS; Kathleen Ell, DSW; Shinyi Wu, PhD
Suggested citation for this article: Wu B, Jin H, Vidyanti I, Lee P, Ell K, Wu S. Collaborative Depression Care Among Latino Patients in Diabetes Disease Management, Los Angeles, 2011–2013. Prev Chronic Dis 2014;11:140081. DOI: http://dx.doi.org/10.5888/pcd11.140081
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EDITOR Camille Martin, Technical Writer/Editor, Preventing Chronic Disease. Disclosure: Camille Martin has disclosed no relevant financial relationships. CME AUTHOR Charles P. Vega, MD, Clinical Professor of Family Medicine, University of California, Irvine. Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships: Served as an advisor or consultant for: McNeil Pharmaceuticals. AUTHORS AND CREDENTIALS Disclosures: Brian Wu, BS; Haomiao Jin, MS; Irene Vidyanti, MEng; Pey-Jiuan Lee, MS; Kathleen Ell, DSW; Shinyi Wu, PhD have disclosed no relevant financial relationships. Affiliations: Brian Wu, Haomiao Jin, Irene Vidyanti, Pey-Jiuan Lee, Kathleen Ell, University of Southern California, Los Angeles, California; Shinyi Wu, RAND Corporation, Santa Monica, California. |
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Abstract
Introduction
The prevalence of comorbid diabetes and depression is high, especially in low-income Hispanic or Latino patients. The complex mix of factors in safety-net care systems impedes the adoption of evidence-based collaborative depression care and results in persistent disparities in depression outcomes. The Diabetes–Depression Care-Management Adoption Trial examined whether the collaborative depression care model is an effective approach in safety-net clinics to improve clinical care outcomes of depression and diabetes.
The prevalence of comorbid diabetes and depression is high, especially in low-income Hispanic or Latino patients. The complex mix of factors in safety-net care systems impedes the adoption of evidence-based collaborative depression care and results in persistent disparities in depression outcomes. The Diabetes–Depression Care-Management Adoption Trial examined whether the collaborative depression care model is an effective approach in safety-net clinics to improve clinical care outcomes of depression and diabetes.
Methods
A sample of 964 patients with diabetes from 5 safety-net clinics were enrolled in a quasi-experimental study that included 2 arms: usual care, in which primary medical providers and staff translated and adopted evidence-based depression care; and supportive care, in which providers of a disease management program delivered protocol-driven depression care. Because the study design established individual treatment centers as separate arms, we calculated propensity scores that interpreted the probability of treatment assignment conditional on observed baseline characteristics. Primary outcomes were 5 depression care outcomes and 7 diabetes care measures. Regression models with propensity score covariate adjustment were applied to analyze 6-month outcomes.
A sample of 964 patients with diabetes from 5 safety-net clinics were enrolled in a quasi-experimental study that included 2 arms: usual care, in which primary medical providers and staff translated and adopted evidence-based depression care; and supportive care, in which providers of a disease management program delivered protocol-driven depression care. Because the study design established individual treatment centers as separate arms, we calculated propensity scores that interpreted the probability of treatment assignment conditional on observed baseline characteristics. Primary outcomes were 5 depression care outcomes and 7 diabetes care measures. Regression models with propensity score covariate adjustment were applied to analyze 6-month outcomes.
Results
Compared with usual care, supportive care significantly decreased Patient Health Questionnaire-9 scores, reduced the number of patients with moderate or severe depression, improved depression remission, increased satisfaction in care for patients with emotional problems, and significantly reduced functional impairment.
Compared with usual care, supportive care significantly decreased Patient Health Questionnaire-9 scores, reduced the number of patients with moderate or severe depression, improved depression remission, increased satisfaction in care for patients with emotional problems, and significantly reduced functional impairment.
Conclusion
Implementing collaborative depression care in a diabetes disease management program is a scalable approach to improve depression outcomes and patient care satisfaction among patients with diabetes in a safety-net care system.
Implementing collaborative depression care in a diabetes disease management program is a scalable approach to improve depression outcomes and patient care satisfaction among patients with diabetes in a safety-net care system.
Acknowledgments
Financial support for this study was provided by the Assistant Secretary for Planning and Evaluation for the US Department of Health and Human Services (no. 1R18AE000054-01). The University of Southern California Institutional Review Board (no. HS-10-00466) and Los Angeles Biomedical Research Institute (no. 20256-01) granted approval for this study. The authors acknowledge the clinics, providers, and patients in the Los Angeles County Department of Health Services (LACDHS) who participated in the study. We also acknowledge the leaders and staff of the Disease Management Program in Research and Innovation of the LACDHS, the research team, and the technology team for their contributions to the study. Special thanks to the following people for their significant contributions to and/or support of the study: Jeffrey Guterman, MD, Sandra Gross-Schulman, MD, Laura Sklaroff, MA, Geoffrey Scheib, BA, Chien-Ju Wang, MS, Davin Agustines, MD, Robert Dasher, MD, Mark Richman, MD, Alex Kopelowicz, MD, Vahid Mahabadi, MD, Eli Ipp, MD, Uzma Haider, MD, Ramani Lakshman, MD, M. J. Michael Allevato, MD, G. Mike Roybal, MD, Stanley Leong, MD, Sharon Graham, MD, and Chih-Ping Chou, PhD. This article was awarded honorable mention in the 2014 Preventing Chronic Disease Student Research Paper Contest.
Author Information
Corresponding Author: Shinyi Wu, PhD, Associate Professor, School of Social Work and Epstein Department of Industrial and Systems Engineering, University of Southern California, 669 W 34th St, Montgomery Ross Fisher Bldg, Los Angeles, CA 90089-0411. Telephone: 213-821-6442. E-mail: shinyiwu@usc.edu.
Author Affiliations: Brian Wu, Haomiao Jin, Irene Vidyanti, Pey-Jiuan Lee, Kathleen Ell, University of Southern California, Los Angeles, California; Shinyi Wu, RAND Corporation, Santa Monica, California.
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