IMPACT: Adaptations

overview
planning implementation
building the team
adaptations
billing and finance

The original study tested IMPACT in 18 clinics associated with eight diverse healthcare organizations across the United States.IMPACT proved to be significantly more effective than usual depression care in all eight organizations, even those that had already had co-located mental health services in the primary care setting. Since the end of the study, numerous adaptations have been made for different populations and settings.

Learn more: table outlining key components

Research studies and evaluations of these programs show that IMPACT is effective with a range of depressed patients:

adults of all ages
diabetics
cancer patients
adolescents

Clinical environments that adapt quality improvement programs to fit their own needs are most likely to sustain them. Toward that end, we encourage practices to adapt the IMPACT model to fit their own organization. To insure that these adaptations do not dilute the effects of the program, we developed a list of key components that are critical to the success of the intervention.

We also encourage organizations to use patient outcomes as a benchmark for measuring program effectiveness. Comparing these outcomes to the original research study and to published adaptations/implementations allows organizations to measure whether the program is having the desired effect in their environment.

Learn more: brief bibliography of adaptations

Learn more: abstracts of the five evaluations

To date, several evaluations of IMPACT adaptations have been completed and most are published. One describes a pilot program at Kaiser Permanente San Diego following conclusion of the original IMPACT trial. The strength of results from this pilot study led to region-wide implementation. The second evaluation examines adaptation of IMPACT for use with low-income Latino diabetics enrolled in a diabetes care management program. The third evaluation reports on a randomized controlled trial among low-income patients with cancer. The fourth evaluation reports on implementation of IMPACT among older adults at safety net clinics in New York City. And the fifth reports on a randomized controlled trial among HMO patients with depression and diabetes.

Graphs adapted from: L. Grypma et al., General Hospital Psychiatry 28 (2006) 101–107.