TY - JOUR
AU - K. J. Coleman
AU - M. Dreskin
AU - D. L. Hackett
AU - A. Aunskul
AU - J. Liu
AU - T. M. Imley
AU - A. L. Wolfner
AU - G. F. Beaubrun
A1 - 
AB - 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.
AD - Department of Research and Evaluation, Kaiser Permanente Southern California , 100 S. Los Robles, Pasadena, CA, 91104, USA. Karen.J.Coleman@kp.org.; Department of Family Medicine, Los Angeles Medical Center, Kaiser Permanente Southern California , Los Angeles, CA, USA.; Department of Psychiatry, Riverside Medical Center, Kaiser Permanente Southern California , Riverside, CA, USA.; Complete Care Support Programs, Kaiser Permanente Southern California, Pasadena, CA, USA.; Department of Research and Evaluation, Kaiser Permanente Southern California , 100 S. Los Robles, Pasadena, CA, 91104, USA.; Quality and Clinical Analysis, Kaiser Permanente Southern California, Pasadena, CA, USA.; Department of Family Medicine, Irvine Medical Center, Kaiser Permanente Southern California, Irvine, CA, USA.; Department of Psychiatry, South Bay Medical Center, Kaiser Permanente Southern California , Harbor City, CA, USA.
BT - Journal of general internal medicine
C5 - Education & Workforce; Measures
CP - Suppl 2
DO - 10.1007/s11606-020-06102-8
IS - Suppl 2
JF - Journal of general internal medicine
LA - eng
M1 - Journal Article
N2 - 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.
PY - 2020
SN - 1525-1497; 0884-8734; 0884-8734
SP - 839
EP - 848
EP - 
T1 - A Roadmap for Institutionalizing Collaborative Care for Depression in a Large Integrated Healthcare System
T2 - Journal of general internal medicine
TI - A Roadmap for Institutionalizing Collaborative Care for Depression in a Large Integrated Healthcare System
U1 - Education & Workforce; Measures
U2 - 33107004
U3 - 10.1007/s11606-020-06102-8
VL - 35
VO - 1525-1497; 0884-8734; 0884-8734
Y1 - 2020
Y2 - Nov
ER -