12-Month Outcomes of Community Engagement Versus

© 2014 American College of Physicians. Results: At 6 months, the finding that CEP outperformed RS to reduce poor MHRQL was significant but sensitive to underlying statistical assumptions. At 12 months, some analyses suggested that CEP was advantageous to MHRQL, whereas others did not confirm a significant difference favoring CEP. The finding that CEP reduced behavioral health hospitalizations at 6 months was less evident at 12 months and was sensitive to underlying statistical assumptions. Other services use did not significantly differ between interventions at 12 months. Limitation: Data are self-reported, and findings are sensitive to modeling assumptions. Conclusion: In contrast to 6-month results, no consistent effects of CEP on reducing the likelihood of poor MHRQL and behavioral health hospitalizations were found at 12 months. Still, given the needs of underresourced communities, the favorable profile of CEP, and the lack of evidencebased alternatives, CEP remains a viable strategy for policymakers and communities to consider. Primary Funding Source: National Institute of Mental Health, Robert Wood Johnson Foundation, California Community Foundation, National Library of Medicine, and National Institutes of Health/ National Center for Advancing Translational Science for the UCLA Clinical and Translational Science Institute. Background: Depression collaborative care implementation using community engagement and planning (CEP) across programs improves 6-month client outcomes in minority communities, compared with technical assistance to individual programs (resources for services [RS]). However, 12-month outcomes are unknown. Objective: To compare effects of CEP and RS on mental healthrelated quality of life (MHRQL) and use of services among depressed clients at 12 months. Design: Matched health and community programs (n = 93) in 2 communities randomly assigned to receive CEP or RS. (ClinicalTrials.gov: NCT01699789). Measurements: Self-reported MHRQL and services use at baseline, 6 months, and 12 months. Setting: Los Angeles, California. Patients: 1018 adults with depressive symptoms (8-item Patient Health Questionnaire score =10), 88% of whom were an ethnic minority. Intervention: CEP and RS to implement depression collaborative care. Measurements: The primary outcome was poor MHRQL (12-item mental health composite score -40) at baseline, 6 months, and 12 months; the secondary outcome was use of services at 12 months. Copyright Information: All rights reserved unless otherwise indicated. Contact the author or original publisher for any necessary permissions. eScholarship is not the copyright owner for deposited works. Learn more at http://www.escholarship.org/help_copyright.html#reuse 12-Month Outcomes of Community Engagement Versus Technical Assistance to Implement Depression Collaborative Care A Partnered, Cluster, Randomized, Comparative Effectiveness Trial Bowen Chung, MD, MSHS*; Michael Ong, MD, PhD; Susan L. Ettner, PhD; Felica Jones, AA; James Gilmore, MBA; Michael McCreary, MPP; Cathy Sherbourne, PhD; Victoria Ngo, PhD; Paul Koegel, PhD; Lingqi Tang, PhD; Elizabeth Dixon, PhD; Jeanne Miranda, PhD; Thomas R. Belin, PhD; and Kenneth B. Wells, MD, MPH* Background: Depression collaborative care implementation using community engagement and planning (CEP) across programs improves 6-month client outcomes in minority communities, compared with technical assistance to individual programs (resources for services [RS]). However, 12-month outcomes are unknown. Objective: To compare effects of CEP and RS on mental health– related quality of life (MHRQL) and use of services among depressed clients at 12 months. Design: Matched health and community programs (n 93) in 2 communities randomly assigned to receive CEP or RS. (ClinicalTrials.gov: NCT01699789). Measurements: Self-reported MHRQL and services use at baseline, 6 months, and 12 months. Setting: Los Angeles, California. Patients: 1018 adults with depressive symptoms (8-item Patient Health Questionnaire score 10), 88% of whom were an ethnic minority. Intervention: CEP and RS to implement depression collaborative care. Measurements: The primary outcome was poor MHRQL (12-item mental health composite score 40) at baseline, 6 months, and 12 months; the secondary outcome was use of services at 12 months. Results: At 6 months, the finding that CEP outperformed RS to reduce poor MHRQL was significant but sensitive to underlying statistical assumptions. At 12 months, some analyses suggested that CEP was advantageous to MHRQL, whereas others did not confirm a significant difference favoring CEP. The finding that CEP reduced behavioral health hospitalizations at 6 months was less evident at 12 months and was sensitive to underlying statistical assumptions. Other services use did not significantly differ between interventions at 12 months. Limitation: Data are self-reported, and findings are sensitive to modeling assumptions. Conclusion: In contrast to 6-month results, no consistent effects of CEP on reducing the likelihood of poor MHRQL and behavioral health hospitalizations were found at 12 months. Still, given the needs of underresourced communities, the favorable profile of CEP, and the lack of evidence-based alternatives, CEP remains a viable strategy for policymakers and communities to consider. Primary Funding Source: National Institute of Mental Health, Robert Wood Johnson Foundation, California Community Foundation, National Library of Medicine, and National Institutes of Health/ National Center for Advancing Translational Science for the UCLA Clinical and Translational Science Institute. Ann Intern Med. 2014;161:S23-S34. doi:10.7326/M13-3011 www.annals.org For author affiliations, see end of text. * Former Robert Wood Johnson Foundation Clinical Scholar. Depression and depressive symptoms are main causes of disability in the United States (1, 2), where racial disparities persist in access to and quality and outcomes of care (3–9). Depression collaborative care provided in primary care settings can improve quality and outcomes of care for depressed adults while reducing outcome disparities by race (10–18), but safety-net primary care settings generally have limited capacity for full implementation of collaborative care (19–21). Encouraging safety-net clinics to collaborate with other key agencies (for example, social services or faith-based organizations) using community engagement (22–26) may support successful implementation of depression collaborative care across underresourced communities. Community Partners in Care (CPIC) was designed to compare the effects of 2 depression collaborative care implementation approaches: 1) community engagement and planning (CEP), which supports collaborative planning and implementation across myriad community programs, and 2) more traditional resources for services (RS) models, which rely on time-limited expert technical assistance for collaborative care to individual programs (27–29). Earlier This article is part of the Annals supplement “RWJF Clinical Scholars in Pursuit of the Value Proposition: Evaluations of Low-Cost Innovations for Prevention and Management of Conditions.” The Robert Wood Johnson Foundation provided funding for publication of this supplement, which is only available online at www.annals.org. Carol M. Mangione, MD, MPH (co-director of the RWJF Clinical Scholars Program at the University of California, Los Angeles); Jaya K. Rao, MD, MHS (Annals Deputy Editor); and Christine Laine, MD, MPH (Annals Editor in Chief), served as editors for this supplement. See also: