Table 3.
Bivariate Analysis* of Organizational Readiness Factors and Primary Care Practice Setting Demographics Against Adoption of Collocation, TIDES†, BHL‡, or No Depression Care Improvement Model
| Independent variables | Practices with Collocation n = 72 / 223 OR [95 % CI] | Practices with TIDES, n = 35 / 210 OR [95 % CI] | Practices with BHL, N = 17 / 212 OR [95 % CI] | Practices with No Depression Care Improvement Model, N = 101 / 225 OR [95 % CI] |
|---|---|---|---|---|
| Organizational Readiness for Change: Adequacy of resources | ||||
| Financial insufficiency | 0.97 [0.67, 1.39] | 0.91 [0.57, 1.46] | 0.35 [0.17, 0.72] ** | 1.43 [1.01, 2.03] * |
| Sufficiency of space | 0.85 [0.64, 1.14] | 1.09 [0.75, 1.59] | 1.91 [1.07, 3.38] * | 0.93 [0.71, 1.22] |
| Sufficiency for information technology (IT) support | 0.85 [0.60, 1.20] | 1.61 [1.01, 2.57] * | 1.31 [0.70, 2.45] | 0.83 [0.60, 1.15] |
| Clinical provider insufficiency | 1.01 [0.70, 1.47] | 1.14 [0.71, 1.81] | 1.09 [0.56, 2.10] | 0.91 [0.64, 1.29] |
| Organizational Readiness for Change: Staff attributes | ||||
| Clinician champion in clinic for depression treatment | 2.37 [1.17, 4.78] * | 0.59 [0.20, 1.78] | 0.65 [0.14, 2.98] | 0.63 [0.31, 1.29] |
| Psychiatrist on primary care staff | 1.00 [0.54, 1.88] | 0.98 [0.44, 2.17] | 7.57 [2.53, 22.61] ** | 0.53 [0.29, 0.97] * |
| Psychologist on primary care staff | 1.92 [1.06, 3.48] * | 1.02 [0.47, 2.22] | 2.80 [1.03, 7.64] * | 0.38 [0.21, 0.70] ** |
| Social worker on primary care staff | 0.81 [0.42, 1.56] | 1.93 [0.71, 5.27] | 0.98 [0.30, 3.16] | 0.90 [0.48, 1.70] |
| Organizational Readiness for Change: Motivation for change | ||||
| Retreat for depression training | 1.16 [0.45, 2.95] | 0.53 [0.12, 2.42] | 0.72 [0.09, 5.93] | 1.25 [0.50, 3.11] |
| Located in a VA regional network that endorsed TIDES | 0.92 [0.43, 2.00] | 8.50 [3.76, 19.20] ** | 0.73 [0.16, 3.37] | 0.20 [0.08, 0.50] ** |
| Organizational Readiness for Change: Organizational climate | ||||
| Teamwork | 1.09 [0.80, 1.48] | 1.08 [0.73, 1.62] | 1.23 [0.72, 2.09] | 0.84 [0.63, 1.12] |
| Communication and cooperation | 1.02 [0.63, 1.67] | 1.47 [0.78, 2.77] | 2.56 [1.05, 6.24] * | 0.60 [0.38, 0.97] * |
| Orientation towards quality improvement | 2.25 [1.36, 3.72] ** | 0.98 [0.55, 1.74] | 1.61 [0.70, 3.69] | 0.44 [0.28, 0.70] ** |
| Competing demands and stress | 0.89 [0.53, 1.50] | 1.18 [0.60, 2.33] | 0.58 [0.23, 1.44] | 1.18 [0.72, 1.92] |
| Internal authority over primary care clinic | 1.00 [0.69, 1.46] | 1.22 [0.75, 2.00] | 0.71 [0.37, 1.37] | 0.97 [0.69, 1.38] |
| External authority over relationship with subspecialists | 1.02 [0.69, 1.50] | 1.20 [0.73, 1.96] | 1.51 [0.75, 3.04] | 0.79 [0.54, 1.14] |
| Resistance | 0.96 [0.66, 1.39] | 0.89 [0.55, 1.43] | 0.85 [0.46, 1.59] | 1.16 [0.82, 1.65] |
| Primary Care Practice Setting Organizational Demographics | ||||
| Clinic size | ||||
| • Medium (20,001–40,000 patients) compared to small | 0.73 [0.37, 1.42] | 1.70 [0.71, 4.05] | 1.05 [0.35, 3.10] | 1.00 [0.53, 1.87] |
| • Large (40,001–108,715 patients) compared to small | 0.67 [0.33, 1.35] | 1.76 [0.72, 4.28] | 0.38 [0.08, 1.84] | 1.32 [0.69, 2.52] |
| Academic affiliation | 0.97 [0.55, 1.70] | 1.49 [0.71, 3.13] | 0.43 [0.15, 1.21] | 1.06 [0.62, 1.79] |
| Located within VA Medical center (versus community) | 0.79 [0.44, 1.39] | 1.74 [0.79, 3.83] | 0.69 [0.25, 1.86] | 1.04 [0.61, 1.78] |
* p < 0.05, bold numbers are significant, ** p < 0.01
† TIDES=Translating Initiatives for Depression into Effective Solutions
‡ BHL=Behavioral Health Laboratory