A Roadmap for Institutionalizing Collaborative Care for Depression in a Large Integrated Healthcare System
BACKGROUND: Collaborative models for depression have not been widely adopted throughout the USA, possibly because there are no successful roadmaps for implementing these types of models.
OBJECTIVE: To provide such a roadmap through a case study of the institutionalization of a depression care management (DCM) initiative for adult depression in a large healthcare system serving over 300,000 adults with depression.
DESIGN: A retrospective observational program evaluation. Program evaluation results are presented for those patients enrolled in the initiative from January 1, 2015, to December 31, 2018.
PARTICIPANTS: Over a 4-year period, 17,052 patients were treated in the DCM program. In general, participants were women (76%), were Hispanic (47%), spoke English (84%), and were 51.1 ± 18.3 years old, the majority of whom were 30-64 years old (57%).
INTERVENTION: The collaborative care portion of the DCM initiative (DCM program) was implemented by a collaborative care team containing a treatment specialist, an assessment specialist, administrative staff, a primary care physician, and a psychiatry physician.
MAIN MEASURES: The main outcome measures were total score on the 9-item Patient Health Questionnaire (PHQ-9). Outcomes were improvement (defined as at least 50% reduction in symptoms) and remission (defined as a PHQ-9 less than 5) of depression symptoms. Follow-up of depression symptoms was also collected at 6 months following discharge.
KEY RESULTS: The average course of treatment in 2018, after full implementation, was 4.6 ± 3.0 months; 62% of patients experienced improvement in symptoms, and 45% experienced remission of their depression at the time of discharge. These rates were maintained at the 6-month follow-up.
CONCLUSIONS: Collaborative care for depression can be institutionalized in large healthcare systems and be sustained with a specific, detailed roadmap that includes workflows, training, treatment guidelines, and clear documentation standards that are linked to performance metrics. Extensive stakeholder engagement at every level is also critical for success.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:35 |
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| Enthalten in: |
Journal of general internal medicine - 35(2020), Suppl 2 vom: 26. Nov., Seite 839-848 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Coleman, Karen J [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 14.05.2021 Date Revised 02.11.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s11606-020-06102-8 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 2 | |a A Roadmap for Institutionalizing Collaborative Care for Depression in a Large Integrated Healthcare System |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Collaborative models for depression have not been widely adopted throughout the USA, possibly because there are no successful roadmaps for implementing these types of models | ||
| 520 | |a OBJECTIVE: To provide such a roadmap through a case study of the institutionalization of a depression care management (DCM) initiative for adult depression in a large healthcare system serving over 300,000 adults with depression | ||
| 520 | |a DESIGN: A retrospective observational program evaluation. Program evaluation results are presented for those patients enrolled in the initiative from January 1, 2015, to December 31, 2018 | ||
| 520 | |a PARTICIPANTS: Over a 4-year period, 17,052 patients were treated in the DCM program. In general, participants were women (76%), were Hispanic (47%), spoke English (84%), and were 51.1 ± 18.3 years old, the majority of whom were 30-64 years old (57%) | ||
| 520 | |a INTERVENTION: The collaborative care portion of the DCM initiative (DCM program) was implemented by a collaborative care team containing a treatment specialist, an assessment specialist, administrative staff, a primary care physician, and a psychiatry physician | ||
| 520 | |a MAIN MEASURES: The main outcome measures were total score on the 9-item Patient Health Questionnaire (PHQ-9). Outcomes were improvement (defined as at least 50% reduction in symptoms) and remission (defined as a PHQ-9 less than 5) of depression symptoms. Follow-up of depression symptoms was also collected at 6 months following discharge | ||
| 520 | |a KEY RESULTS: The average course of treatment in 2018, after full implementation, was 4.6 ± 3.0 months; 62% of patients experienced improvement in symptoms, and 45% experienced remission of their depression at the time of discharge. These rates were maintained at the 6-month follow-up | ||
| 520 | |a CONCLUSIONS: Collaborative care for depression can be institutionalized in large healthcare systems and be sustained with a specific, detailed roadmap that includes workflows, training, treatment guidelines, and clear documentation standards that are linked to performance metrics. Extensive stakeholder engagement at every level is also critical for success | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 700 | 1 | |a Dreskin, Mark |e verfasserin |4 aut | |
| 700 | 1 | |a Hackett, Daniel L |e verfasserin |4 aut | |
| 700 | 1 | |a Aunskul, Alisa |e verfasserin |4 aut | |
| 700 | 1 | |a Liu, Jialuo |e verfasserin |4 aut | |
| 700 | 1 | |a Imley, Tracy M |e verfasserin |4 aut | |
| 700 | 1 | |a Wolfner, Amy L |e verfasserin |4 aut | |
| 700 | 1 | |a Beaubrun, Gabrielle F |e verfasserin |4 aut | |
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