A Roadmap for Institutionalizing Collaborative Care for Depression in a Large Integrated Healthcare System

Abstract

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.

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Acknowledgments

Parts of this evaluation were presented at the National American Heart Association scientific sessions in Anaheim, CA, on November 12, 2017, and at the National Kaiser Permanente Quality Conference in Oakland, CA, on June 20, 2018.

Funding

Funding for this study was provided by the Southern California Permanente Medical Group.

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Correspondence to Karen J. Coleman PhD.

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Coleman, K.J., Dreskin, M., Hackett, D.L. et al. A Roadmap for Institutionalizing Collaborative Care for Depression in a Large Integrated Healthcare System. J GEN INTERN MED 35, 839–848 (2020). https://doi.org/10.1007/s11606-020-06102-8

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