Benjamin Springgate1, Lingqi Tang2, Michael Ong3, Wayne Aoki4, Bowen Chung5, Elizabeth Dixon6, Megan Dwight Johnson7, Felica Jones8, Craig Landry2, Elizabeth Lizaola2, Norma Mtume9, Victoria K Ngo10, Esmeralda Pulido11, Cathy Sherbourne12, Aziza Lucas Wright13, Yolanda Whittington14, Pluscedia Williams15, Lily Zhang2, Jeanne Miranda16, Thomas Belin17, James Gilmore18, Loretta Jones19, Kenneth B Wells20. 1. Louisiana State University, Department of Medicine, School of Medicine, New Orleans, LA. 2. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA. 3. David Geffen School of Medicine at UCLA, Los Angeles CA. 4. Los Angeles Christian Health Centers, Los Angeles CA. 5. Los Angeles County Department of Mental Health Services, UCLA-Harbor General Hospital, David Geffen School of Medicine and Semel Institute at UCLA, RAND Health Program, Los Angeles CA. 6. School of Nursing, University of California, Los Angeles, Los Angeles CA. 7. Greater Los Angeles Veteran Affairs Health Care System, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles CA. 8. Healthy African American Families II, Los Angeles, CA. 9. Shields for Families, Los Angeles CA. 10. The RAND Corporation, Los Angeles CA. 11. University of Washington Medical Center, Seattle, WA. 12. The RAND Corporation, Santa Monica CA. 13. The RAND Corporation, Healthy African American Families II, New Vision Church of Jesus Christ, Los Angeles CA. 14. Los Angeles Department of Mental Health, Los Angeles CA. 15. Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles, CA. 16. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles CA. 17. Department of Biostatistics, Fielding School of Public Health, South Los Angeles CA. 18. Behavioral Health Services, Gardena, CA. 19. Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles CA. 20. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health at UCLA; RAND Health Program, Los Angeles CA.
Abstract
Significance: Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Resources for Services (RS) for program technical assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical conditions (MCC) are unknown. Objective: To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups. Design: Secondary analyses of a cluster-randomized trial. Setting: 93 health care and community-based programs in two neighborhoods. Participants: Of 4,440 clients screened, 1,322 depressed (Patient Health Questionnaire, PHQ8) provided contact information, 1,246 enrolled and 1,018 (548 with ≥3 MCC) completed baseline, 6- or 12-month surveys. Intervention: CEP or RS for implementing depression quality improvement programs. Outcomes and Analyses: Primary: depression (PHQ9 <10), poor MHRQL (Short Form Health Survey, SF-12<40); Secondary: mental wellness, good physical health, behavioral health hospitalization, chronic homelessness risk, work/workloss days, services use at 6 and 12 months. End-point regressions were used to estimate intervention effects on outcomes for subgroups with ≥3 MCC, non-MCC, and intervention-by-MCC interactions (exploratory). Results: Among MCC clients at 6 months, CEP vs RS lowered likelihoods of depression and poor MHRQL; increased likelihood of mental wellness; reduced work-loss days among employed and likelihoods of ≥4 behavioral-health hospitalization nights and chronic homelessness risk, while increasing faith-based and park community center depression services; and at 12 months, likelihood of good physical health and park community center depression services use (each P<.05). There were no significant interactions or primary outcome effects for non-MCC. Conclusions: CEP was more effective than RS in improving 6-month primary outcomes among depressed MCC clients, without significant interactions.
RCT Entities:
Significance: Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Resources for Services (RS) for program technical assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical conditions (MCC) are unknown. Objective: To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups. Design: Secondary analyses of a cluster-randomized trial. Setting: 93 health care and community-based programs in two neighborhoods. Participants: Of 4,440 clients screened, 1,322 depressed (Patient Health Questionnaire, PHQ8) provided contact information, 1,246 enrolled and 1,018 (548 with ≥3 MCC) completed baseline, 6- or 12-month surveys. Intervention: CEP or RS for implementing depression quality improvement programs. Outcomes and Analyses: Primary: depression (PHQ9 <10), poor MHRQL (Short Form Health Survey, SF-12<40); Secondary: mental wellness, good physical health, behavioral health hospitalization, chronic homelessness risk, work/workloss days, services use at 6 and 12 months. End-point regressions were used to estimate intervention effects on outcomes for subgroups with ≥3 MCC, non-MCC, and intervention-by-MCC interactions (exploratory). Results: Among MCC clients at 6 months, CEP vs RS lowered likelihoods of depression and poor MHRQL; increased likelihood of mental wellness; reduced work-loss days among employed and likelihoods of ≥4 behavioral-health hospitalization nights and chronic homelessness risk, while increasing faith-based and park community center depression services; and at 12 months, likelihood of good physical health and park community center depression services use (each P<.05). There were no significant interactions or primary outcome effects for non-MCC. Conclusions: CEP was more effective than RS in improving 6-month primary outcomes among depressed MCC clients, without significant interactions.
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