A Community-Partnered, Participatory, Cluster-Randomized Study of Depression Care Quality Improvement: Three-Year Outcomes

Abstract

OBJECTIVE For implementing quality improvement programs for depression in underserved communities, a multi-sector coalition approach (Community-Engagement and Planning, CEP) was more effective than program technical assistance (Resources for Services, RS) in improving mental health-related quality of life (MHRQL), reducing behavioral health hospitalizations and shifting services toward community-based programs at 6-months. At 12-months there was continued evidence of improvement. This study objective was to evaluate for continued evidence of improvement at 3-years. METHOD Three-year extension study for Community Partners in Care (CPIC), a community-partnered cluster-randomized trial with 93 Los Angeles health and community programs assigned to CEP or RS having 1004 enrolled depressed clients eligible for 3-year follow-up and 600 completing surveys from 89 programs. Multiple regression analyses with multiple imputation controlling for baseline status and covariates are used to estimate intervention effects on poor MHRQL and depression; physical health-related quality of life (PHRQL) and behavioral health hospital nights; and healthcare, community program and medication use. RESULTS CEP versus RS did not affect 3-year depression or MHRQL but had modest effects on improving PHRQL and reducing behavioral health hospital nights; and increased having any social-community sector visit for depression and use of mood stabilizers. Sensitivity analyses with longitudinal modeling reproduced findings, but for differences between intervention groups in change from baseline to 3-years, effects were not significant. CONCLUSIONS At 3-years, CEP versus RS did not affect primary mental health outcomes but had modest effects on improving PHRQL and reducing behavioral hospital nights.

Community Partnering for Behavioral Health Equity: Public Agency and Community Leaders’ Views of its Promise and Challenge

“…HNI was inspired by the Community Partners in Care (CPIC) study, which used a clusterrandomized controlled trial to compare two approaches to implementing expanded collaborative care, a partnered strategy vs a technical assistance strategy, in two predominantly minority, under-resourced communities in LAC. [15][16][17] CPIC's partnered approach, called Community Engagement and Planning (CEP), emphasized power-sharing through two-way capacity building, respect for diversity, community wisdom, use of evidence-based practices, an assetbased approach, and transparency to promote equal authority among partners in all phases of a project.…”

Community Engagement and Planning versus Resources for Services for Implementing Depression Quality Improvement: Exploratory Analysis for Black and Latino Adults

“…These concerns have been previously examined and demonstrated as either of modest and decreasing bias, to have under-estimated CEP contribution, or to not significantly impact the efficacy of care delivery. 21,29 With regard to this secondary analysis specifically, CPIC was not powered to detect differences in racial/ethnic subgroups, and may therefore under-estimate the potential impact of community participatory interventions. Similarly, this study's limited sample size prevents nuanced examination of outcomes according to the diversity within the two racial/ ethnic groups themselves (eg, according to primary language or nation of birth among Latino participants 11 ).…”

“…To monitor use across interventions, CEP program administrators were provided with a list of participants and the fidelity of intervention assignment was tracked over time. 21…”

Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions

“…31,33 Reduced effects at 12 months may partly be due to lower exposure over time to depression services in the assigned intervention. 54 Future research is needed to understand mechanisms underlying initial benefits of CEP relative to RS and reduced effects over time, to inform research on determining how to sustain effects.…”