• Improving Depression Care - National Depression Management Leadership Initiative

    Study Description and Methods

    This study was a combination of Quality Improvement (QI) and practice-based research activities. By having members of each practice utilize quality improvement tools, we tested strategies for making and sustaining improved depression care. This also allowed us to assess the clinical utility of simple quantitative instruments (i.e., PHQ-9) that measure the severity of depression.

    Specific Aims and Objectives

    Our specific aims were:

    1. To identify and test simple office systems that enhance depression care through improved follow-up to monitor and adjust treatment during acute and continuing phase treatment of depression.
    2. To examine characteristics of office practices (values, structures, and processes) that are associated with initial adoption of these innovative strategies and with sustaining them over time.
    3. To identify and test strategies that can be used by practices to diffuse use of strategies beyond the 'champions' for improved depression care to other clinicians and care teams in the practice.
    4. To test strategies for assisting practices in developing effective Improvement Teams to implement, diffuse, and sustain chronic care office systems for care of depression and expanding their use to other chronic conditions.


    This study was conducted from October 1, 2004, through March 31, 2006.


    This project has been completed. Please see below for Key Findings and Publications.

    Key Findings and Publications

    The program led to measurable improvements in implementation of office procedures and systems known to improve depression care. The improvements were both sustained beyond the end of the program and substantially diffused to the other clinicians in the practice.

    Access the complete manuscript:

    Integrating Practice Change Processes into Quality Improvement of Depression Care: A report from the National Depression Management Leadership Initiative’s Improving Depression Care project. Main DS, Graham DG, Nutting PA, et al.  Jt Comm J Qual Patient Saf 2009;35(7):351-357

    It Takes Two:  Using Co-Leaders to Champion Improvements in Small Primary Care Practices. Gallagher KM, Nutting PA, Nease DE, et al. J Am Board Fam Med. 2010;23(5):632-639.

    Systematic Use of Patient-Rated Depression Severity Monitoring: Is It Helpful and Feasible in Clinical Psychiatry? Duffy FF, Chung H, Trivedi M, et al. Psych Serv. 2008;59:1148-1154.

    Inducing Sustainable Improvement in Depression Care in Primary Care Practices: A Report from the National Depression Management Leadership Initiative's Improving Depression Care Project. Nease DE, Nutting PA, Dickinson WP, et al. Jt Comm J Qual Patient Saf 2008;34(5):247-255.

    Contact Information

    For additional information about this study, please contact:

    AAFP National Research Network
    1-800-274-2237 x3180

    This project was funded by grants from AstraZeneca International, Eli Lilly and Company, Lilly Foundation, Forest Laboratories, Inc., Pfizer Inc., Sanofi Aventis, and Wyeth.