TAKING ISSUE Editor

Editor
Howard H. Goldman, M.D., Ph.D.
John A.Talbott, M.D.
Eddiittoorriaial lBB
E
DavidA.A.Adler,
oaoradrd
M.D.
Carol Bernstein, M.D.
Carol
Lisa B. A.
Dixon, Bernstein, M.D.
M.D., M.P.H.
Benjamin
H. Richard Lamb, G. Druss,
M.D.M.D., M.P. H.
StephenR.R.Marder,
Stephen Marder, M.D.
M.D.
Grayson
Betty S. Norquist,
Pfefferbaum, M.D.,M.D.,
J.D. M.S.P.H.
Pedro Ruiz,
Michelle M.D.
B. Riba, M.D., M.S.
BradleyA.D.
Robert Stein, M.D.,
Rosenheck, M.D.Ph.D.
GreerRuiz,
Pedro Sullivan,
M.D. M.D., M.S.P.H.
Marvin
Sally S. Swartz,
L. Satel, M.D. M.D.
MarciaS.Valenstein,
Steven M.D.
Sharfstein, M.D.
EBM and Quality Improvement Research Roy C.Wilson,
Greer Sullivan, M.D., M.D.M.S.P.H.
Bonnie
Peter T. Zima,
Weiden, M.D.M.D., M.P. H.
This issue of Psychiatric Services includes an analysis of two-year follow-up da- IEndteitrodrisE
cim
ple
inraitru
y sAdvisory Board
ta from Partners in Care, a seminal depression quality improvement study con- Richard
John A.Talbott,Birkel, Ph.D.M.D.
ducted during the late 1990s. The results include a finding that is, on its face, Suzanne Dworak-Peck, A.C.S.W.
Book B.
Susan ReFine,
viewM.A.,EditO.T.R.
or
surprising—the Partners in Care intervention appears to have been comparably, Jeffrey L.
Thomas W.Geller,
Hester, M.D.,
M.D. M.P. H.
or possibly even more, cost-effective for minor depression than for major de- Marcia Miller, M.L.S.
Statistical Consultants
Frances Palmer, M.S., O.T.R./L.
pression. How are we to reconcile this result with the fact that other studies have Deborah R. Medoff, Ph.D.
Gail W. Stuart, Ph.D., R.N.
found only limited effectiveness for treatment of subsyndromal depression? Sharon-Lise T. Normand, M.Sc., Ph.D.
Book ReE.
Carole vieSiegel,
w EditoPh.D
r
Answering this question requires recognizing an important but often under- Jeffrey L. Geller, M.D., M.P.H.
Contributing Editors
emphasized distinction—the difference between evidence-based medicine ContrS.
Paul ibuAppelbaum,
ting Editors M.D., Law &
IanPsychiatry
E.Alger, M.D., Multimedia Reviews
(EBM) for clinical care and evidence-based quality improvement. A clinical per- Paul S. Appelbaum, M.D., Lawand
& Psychiatry
Francine Cournos, M.D., Stephen
spective assumes that everyone in a program receives a relatively standardized Francine Cournos, M.D.,
M. Goldfinger, M.D.,Frontline
Frontline Reports
set of services. Persons with more severe conditions stand to gain more from Joshua Freedman,
Reports M.D., Clinical Computing
Jeffrey L. Geller, M.D., M.P.H., Personal
treatment and have lower rates of spontaneous remission than those with milder Jeffrey L. Geller, M.D., M.P. H., Personal
Accounts
Accounts
problems. Thus in clinical studies, effectiveness and cost-effectiveness are typi- William M. Glazer, M.D., Best Practices
William M. Glazer, M.D., Best Practices
cally greater for subjects with the highest degree of symptomatology . Marcia Kraft Goin, M.D., Ph.D., Practical
Fred C. Osher, M.D., State Mental
Psychotherapy
Health Policy
Partners in Care, however, was a quality improvement study, in which the in- Howard H. Goldman, M.D., Ph.D., and
Amy M. Kilbourne, Ph.D., M.P. H., and
Colette Croze, M.S.W., State Mental
tervention was directed at clinical practices rather than to individual patients. Tami L. Mark, Ph.D., Datapoints
Health Policy
Although the project enrolled participants with both major and subthreshold Steven
Marion Z. S.Goldstein,
Sharfstein, M.D.,
M.D., Haiden A.
Practical
Huskamp, Ph.D., and Alison Evans
depression, persons with subthreshold conditions could receive low-intensity Geriatrics
Cuellar, Ph.D., Economic Grand
Douglas H. Hughes, M.D., Emergency
monitoring rather than active psychotherapy or medication management. As a Rounds
Psychiatry
result, incremental health costs for the intervention group in this subpopula- Alex
EditoKopelowicz,
rial ConsulM.D.,
tantsand Robert Paul
tion were extremely modest—less than 5% of the costs for persons with major Liberman,
José Miguel M.D., Rehab
Caldas de Rounds
Almeida, M.D.
Harold
Norman Alan Pincus, M.D.,
Clemens, M.D.and Terri L.
depression. Given that more than 40% of patients in the Partners in Care study Tanielian, M.A., Datapoints
Robert E. Drake, M.D., Ph.D.
had subthreshold rather than major depression, the low cost of treating this James E. Sabin, M.D., Managed Care
Marcia Kraft Goin, M.D., Ph.D.
Sally L. Satel, M.D., Alcohol & Drug Abuse
group is likely to have been an important driver of the intervention’s overall Shelly F. Greenfield, M.D., M.P. H.
Steven S. Sharfstein, M.D., Economic
cost-effectiveness. Marcela Horvitz-Lennon, M.D., M.P. H.
Grand Rounds
Charles Huffine, M.D.
George M. Simpson, M.D., Psychopharm-
Most disease management programs look more like Partners in Care than Matt Muijen, M.D., Ph.D.
acology
Pamela B. Peele, Ph.D.
like interventions from clinical studies. Typically, these programs rely on re- EditSusan
M. orial Co nsultantsJ.D.
Ridgely,
ferrals for identifying patients rather than on full diagnostic assessments and Leona
George L. Bachrach, Ph.D.
M. Simpson, M.D.
include participants with both full and subsyndromal conditions. Once pa- John
LauraO.Van
Lipkin,
ToshM.D.
Theodore W. Lorei, M.S.W.
tients are enrolled, disease managers generally provide supplemental guid- Editorial Staff
Cover Art CoGrant
Constance nsultanGartner,
t Managing
ance and support rather than direct care. The results of the study by Wells and Sally Webster, Ph.D., New York City
Editor
colleagues provide encouraging news for this approach to improving care. By Christine
Editorial StaHamel,
ff Associate Editor
providing low-intensity services to persons with subsyndromal conditions and Demarie S.
Constance Jackson,
Grant Associate
Gartner, ManagingEditor
Editor
more intensive care to individuals with more serious disorders, these programs Wendy Lieberman
Deborah Christie-Smith, Taylor, Production
Associate Editor
Manager
Wendy Lieberman Taylor, Production Editor
have the potential to provide population-based care that is both efficacious Andrew Christian,
Deborah J. Prugar,Administrative
Editorial Assistant
Assistant
and cost-effective.—BENJAMIN G. DRUSS, M.D., M.P.H., Rosalynn Carter Gionne A. Johnson, Editorial Secretary
American Psychiatric Association
Chair in Mental Health, Department of Health Policy and Management, AmericanB.
Carolyn PsRobinowitz,
ychiatric AssocM.D.,
iation President
Emory University Paul
NadaS.L.
Appelbaum, M.D., President
Stotland, M.D., M.P. H.,
Marcia Kraft Goin, M.D., Ph.D., President-
President-Elect
Elect A. Bernstein, M.D., Vice-President
Carol
Michelle
Donna M. B. Riba, M.D.,
Norris, M.S.,Secretary-
M.D., Vice-President
Steven S. Sharfstein, M.D., Vice-President
Treasurer
Pedro Ruiz, M.D., Secretary
Psychiatric Services, established in 1950, is published monthly by the American Psychiatric Associ- Jeffrey Akaka, M.D., Speaker, APA
Carol A. Bernstein, M.D., Treasurer
ation for mental health professionals and others concerned with treatment and services for persons Assembly
Albert Gaw, M.D., Speaker, APA Assembly
with mental illnesses and mental disabilities, in keeping with APA’s objectives to improve care and James H. Scully, M.D., Medical Director
Steven M. Mirin, M.D., Medical Director
treatment, to promote research and professional education in psychiatric and related fields, and to and CEO
advance the standards of all psychiatric services and facilities.

PSYCHIATRIC SERVICES ♦ ps.psychiatryonline.org ♦ October 2007 Vol. 58 No. 10 1255