Each clinic chosen to participate in the SIF initiative through a competitive selection process received clinic-level implementation coaching from the AIMS Center during all phases of implementation, from building a vision of how CoCM fits into their organizational mission and developing a tailored clinical workflow to creating a plan for long-term financial sustainability after their grant ended. The AIMs Center also provided provider-level CoCM training and skill-building to support practice change. This included in-person training supplemented by targeted skills training and case reviews to help care managers expand their skills over time. Psychiatric consultants serving each of the clinics met quarterly with an experience AIMS Center psychiatric consultant to support them in their critically important role and reinforce skills being learned by the care managers.
The AIMS Center research team conducted an evaluation of the initiative. Key findings of this evaluation include:
- Many of the same principles that drive better clinical outcomes for patients also drive better outcomes at the organization level (e.g. measurement-based treatment to target).
- Patients in rural areas can be more challenging to engage and retain in treatment due to travel distances, lack of reliable/available phone service, higher prevalence of social stigma, and more prevalent cultural expectations of independence and stoic self-reliance.
- Implementation is a process that evolves over time and patience with this process can be one of the biggest challenges for clinics and clinicians alike.
- Two of the eight clinics enrolled a significant number of American Indian / Alaska Native patients, the largest number in any prior published depression treatment studies, creating an opportunity to better understand the best way to reach this underserved population.
- Consistent with the AIMS Center’s prior experience with community clinics serving low-income patients, many patients (61%) reported moderately severe or severe depression symptoms at the time they were enrolled in care.
- The number of follow-up contacts was strongly linearly associated with better depression response (50% reduction of symptoms) and remission (near elimination of symptoms) among patients.
- Due to workforce shortages in rural areas, the AIMS Center helped clinics be creative and flexible in addressing the care manager and psychiatric consultant roles.