treated according to the IMPACT model, compared with those receiving usual care, were significantly more likely to receive treatment for their depression at all follow-up periods; report greater satisfaction with their care; have significantly lower scores for depression; have a higher rate of complete remission of depression; experience less health-related impairment in work, family, and social functioning; and report better overall quality of life (Unutzer et al., 2001, 2002).
Partners in Care was a quality improvement intervention for depression care conducted from 1995 to 2000 in 46 primary care clinics within six diverse, nonacademic managed care plans in the western, midwestern, and eastern United States. The study included two programs: one directed at improving depression care using medications and the other at resources to support psychotherapy. Along with quality improvement techniques for changing care delivery (e.g., education of clinical staff in evidence-based depression care), both programs included (1) proactive case detection and clinical assessment; (2) activation of patients to promote knowledge about their condition and motivation to follow treatment regimens; (3) care planning and case management; (4) formal mechanisms for ongoing, effective collaboration between primary care providers and mental health specialists; and (5) follow-up. The two programs proved to be about equally successful. A group-level, randomized controlled trial of the quality improvement interventions found increased rates of appropriate care, decreased symptoms of probable mental illness, and increased health-related quality of life in the intervention group compared with the group receiving usual care (Wells et al., 2000, 2004; RAND Corporation, 2007).
Between 1998 and 2004, The Robert Wood Johnson Foundation funded 22 demonstration projects aimed at developing innovative models for delivering palliative care to people with progressive, life-threatening conditions. Projects in the Promoting Excellence in End-of-Life Care Program varied greatly with respect to their target populations (e.g., pediatric patients, persons with serious mental illness, prison inmates, military veterans, renal dialysis patients, Native Americans, Native Alaskans, African Americans, and inner-city medically underserved populations), geographic areas and settings in which they were located (urban, rural, and frontier settings; integrated health systems; hospitals; outpatient clinics; cancer centers; nursing homes; renal dialysis clinics; inner-city public health and safety net systems; and prisons), and the ways in which the delivery of palliative care was organized.