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2005 HSR&D National Meeting Abstract

3080 — What Does it Take to Implement an Evidence-Based Depression Treatment in Primary Care?

Author List:
Liu CF (Seattle HSR&D)
Kirchner JA (Little Rock HSR&D)
Fortney J (Little Rock HSR&D)
Perkins M (Seattle HSR&D)
Ober S (Louis Stokes DVA Medical C)
Chaney EF (Seattle HSR&D)
Rubenstein LV (Sepulveda HSR&D)

To document activities and estimate cost associated with the translation of an evidence-based depression treatment model into routine primary care. Activities and costs are documented for the Translating Initiatives in Depression Effectiveness Study (TIDES), which adopted and implemented a collaborative model of depression treatment in 7 outpatient clinics in three VISNs.

The evaluation focused on the communication channels needed to move the process forward, including leadership meetings, conferences, training sessions, and email communications. Evaluation and research activities were excluded. Data sources were project records and logs from FY2000 to FY2003, including minutes for expert panel meetings and regular conference calls, emails, and records for informatics development, provider education materials, training program, and care management protocol. Personnel were categorized into key stakeholder groups (VISN, VAMC, and primary care clinic) and TIDES research staff. We categorized activities into key intervention components (leadership/expert panel, model adaptation/collaboration, care management, clinical informatics, and provider education) and project phases (preparation, VISN design, pre-implementation, start-up implementation, and maintenance).

A broad range of personnel in all stakeholder groups participated in the process, including 83 persons contributing 2,663 person hours. The total cost was $61,186 including: $26,602 for leadership/expert panel, $20,365 for care management, $6,067 for clinic informatics, $5,265 for model adaptation/collaboration, $239 for provider education (not including physician attending time), and $2,747 for project coordination. By project phase, the estimated costs were $3,938 for preparation, $33,210 for VISN design, $4,165 for pre-implementation, $9,987 for start-up implementation, and $9,886 for maintenance phase. The costs from the stakeholder groups were similar across VISNs. Thirty eight TIDES research staff contributed 1,920 person hours to the process for a total cost (personnel, software licensing, and travel) of $154,919, including $21,752 for leadership/expert panel, $71,520 for clinical informatics, $8,367 for model adaptation/collaboration, $19,810 for care management, $14,969 for provider education, and $18,501 for project coordination.

The translation process requires substantial upfront investments by sites and researchers. The translation costs are more likely to be underestimated, because this study only measured countable activities through project records.

A successful translation process requires a strong partnership between research and participating sites.

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