From Development to Dissemination

t b a In 1978 the fırst multi-site mental health epidemiologic study in theU.S. reported thatmore than 50%of community respondents with depressive disorders were treated exclusively within the primary care system. As a result, primary care was labeled the “de facto mental health system” for Americans with the more prevalent but less severe mental health disorders. Subsequent research over the next decade found that only 25% to 50%of patients with depressive disorders were accurately diagnosed by primary care physicians. Moreover, among those accurately diagnosed only 50% received minially adequate pharmacologic treatment, and less than 0% received a minimally adequate number of psychoherapy visits. The concept of the collaborative caremodel was developed to attempt to bridge these gaps in the quality of depression care. A multidisciplinary team of researchers at Group Health and the University of Washington helped stimulate development of this model and were nfluenced by the pioneering work on the chronic illness odel of care by Wagner and colleagues. The chronic llnessmodel was developed because of data showing that majority of patients with chronic medical illnesses were ot receiving guideline-level care. Much like the gaps in uality of depression care, only about one third of Amercans with hypertension received effective treatment to ower blood pressure below guideline-recommended levls, and more than 50% of patients with diabetes had bA1c levels above guideline-recommended levels. Wagner and colleagues recognized that improving selfmanagement and guideline-level care for patients with chronic illnesses would be diffıcult with the usual brief, infrequent visits with primary care physicians and would require a team approach. Both the collaborative care model and chronic illness model emphasize three core concepts: population-based care, measurement-based care, and stepped care. Most