The COMPASS (Care Of Mental, Physical And Substance-use Syndromes) initiative, funded by the Center for Medicare & Medicaid Innovation, evaluated the large-scale implementation of the TEAMcare model treating patients with depression and comorbid diabetes and/or cardiovascular disease. The initiative was implemented in 18 medical groups and 172 clinics across eight states. Participating clinics differed significantly in size, organizational structure, patient populations, and payment systems, thus demonstrating the feasibility of implementing the TEAMcare intervention in “real world” clinical settings.
The initiative involved 3,609 Medicare and Medicaid patients in eight states and is one of the largest collaborative care implementations to date. The results of the trial were published in a 2016 issue of General Hospital Psychiatry. Among patients with uncontrolled disease at enrollment, 40% achieved depression response or remission, 23% achieved glucose control and 58% achieved blood pressure control over the 11-month treatment period. There were large variations in outcomes across the medical groups, and rigorous implementation was associated with increased effectiveness. Researchers learned best practices for treating patients in primary care settings who have multiple chronic conditions, demonstrated the model can be effective for the target population when implemented well, and identified financial models that can sustain and scale a multi-condition collaborative care program.
DIAMOND was a collaborative effort of 9 health plans, 25 medical groups, and over 80 primary care clinics in Minnesota to implement and study Collaborative Care for depression. The AIMS Center provided consultation and coaching for the initiative. In addition, the National Institute of Mental Health (NIMH) awarded a $3 million grant to HealthPartners Research Foundation to study the DIAMOND initiative over five years. The study evaluated all aspects of DIAMOND, including effects of the program on patient satisfaction, productivity, and program cost-effectiveness. The project used a patient registry that tracks and measures patient goals and clinical outcomes, and facilitates treatment adjustment if a patient is not improving as expected.
This research project combined IMPACT depression care management with an existing diabetes care management program for low income, predominantly Spanish-speaking Latinx people in San Diego. The study shows that this combined approach is both effective and cost-effective with this population.
The COVID-19 pandemic has caused us all to find new ways to make and maintain connections with others, especially with older adults in our own lives and communities. In response to increasing COVID-related isolation, AIMS Center members and UW faculty developed a program called Stay Connected. Delivered via telehealth, Stay Connected is a program that employs evidence-based behavioral strategies for older adults experiencing loneliness, anxiety, or depression symptoms. Case managers, community health workers, and others working in senior service settings make structured phone calls to a caseload of clients in which they ask targeted questions and provide specific tools and guidance to ward off stress, loneliness, and anxiety. Callers are trained and supported by licensed behavioral health clinicians and psychologists.
“The Stay Connected program helps older adults restructure their day and add self-care and mood boosters.” – Patrick Raue, PhD
The program was developed by AIMS Center members in partnership with organizations participating in an Archstone Foundation-funded project known as Care Partners. Stay Connected was also funded by NIMH as part of the University of Washington School of Medicine ALACRITY Center. In addition, Seattle-King County Aging and Disability Services implemented a brief pilot of the Stay Connected program in 2020.
Read a press release from the UW Medicine Newsroom: Stay Connected program helps isolated seniors
Up to 25% of people with cancer will become clinically depressed, significantly affecting their quality of life and overall functioning. Depression has been associated with a decreased ability to tolerate and complete cancer treatment, as well as significantly increased healthcare costs. Unfortunately, about 75% of cancer patients with depression do not receive adequate treatment, and that likelihood is even greater for patients in rural settings. Although the CoCM model has been shown to be highly effective in the cancer setting, high-fidelity implementation has been slow, particularly in low-resourced and rural areas. The use of technology has the potential to enhance implementation and fidelity of CoCM in diverse cancer settings.
The research project “Using Technology to Optimize Collaborative Care Management of Depression in Urban and Rural Cancer Centers,” funded by the National Cancer Institute, will explore and build on this potential. This study is using a human-centered design approach to develop, build, and test a web and mobile platform to enhance the implementation and fidelity of CoCM of depression for patients being treated at 2 urban and 2 rural cancer centers. Patient-facing web and mobile applications and a clinician-facing website will aim to: (1) enhance treatment engagement among patients and clinicians; (2) collect timely patient-reported outcomes for measurement-based care; (3) promote patient-centered shared decision-making for better treatment adjustments; and (4) maximize adherence to evidence-based guideline-level behavioral and pharmacologic treatments. Once developed, the technology-enhanced CoCM model will be compared to usual CoCM to evaluate their ability to achieve optimal fidelity of CoCM and clinical outcomes.
Around 2.1 million Americans aged 12 years and older had an opioid use disorder (OUD) in 2016. Among adults who misused opioids in the prior year, 43% also had a mental illness. There is strong evidence for the efficacy of the Collaborative Care model (CoCM) in treating common mental health disorders, but not for the treatment of OUD. The CHAMP study (Collaborating to Heal Opioid Addiction and Mental Health in Primary Care) will investigate whether CoCM that addresses both mental health conditions and co-occurring OUD can improve patient lives.
The Department of Psychiatry & Behavioral Science’s Population Health Division and the AIMS Center will support up to 24 primary care clinics in implementing either CoCM for OUD and mental health conditions, or for mental health conditions only. Training for the intervention began in late summer 2020.
Find out more about this clinical trial by visiting the CHAMP website.
Contact
Lori Ferro Phone: (206) 685-7538
Email: ljf9@uw.edu
Webinar
Watch presenter Anna Ratzliff, MD, PhD give an introduction to the project and answer questions from attendees.
Video
Informational Webinar
Presentation Slides
Introduction to CHAMP
Untreated mental health illnesses have serious consequences for families, but fewer than one in four depressed people who identify as mothers receive effective treatment. This project examined depression care and clinical outcomes for pregnant people and people who identify as either mothers or primary caregivers, treated in 14 clinics serving racially and ethnically diverse communities with lower incomes as part of the Mental Health Integration Program (MHIP). The outcome of this project was published in Family Practice. Huang H. et al (2012) found that although there was substantial depression improvement in all four of the ethnic groups studied (Asian, Black, Latinx, White), outcomes of Latinx patients were higher than those of Black patients regardless of other demographic or clinical factors. Notably, this study shows that more intensive care management in the first month of treatment for primary care can lead to better outcomes for pregnant people, and mothers or primary caregivers with lower incomes experiencing depression. Another study describes the experiences of care managers working in this program and found that motivational interviewing skills were a valuable asset in engaging patients in care, which generally leads to better outcomes.
References
- Huang, H., Chan, Y.-F., Katon, W., Tabb, K., Sieu, N., Bauer, A. M., Wasse, J. K., & Unützer, J. (2012). Variations in depression care and outcomes among high-risk mothers from different racial/ethnic groupsV. Family Practice, 29(4), 394–400. https://doi.org/10.1093/fampra/cmr108
- Huang, H., Bauer, A. M., Wasse, J. K., Ratzliff, A., Chan, Y.-F., Harrison, D., & Unützer, J. (2013). Care managers’ experiences in a collaborative care program for high risk mothers with depression. Psychosomatics, 54(3), 272–276. https://doi.org/10.1016/j.psym.2012.07.011
This NIMH funded project is a collaboration between the University of Washington, Emory University and three sites in India (Chennai, Delhi, and Vishakapatnam). This grant will adapt the multicondition TEAMcare model to treat patients with poorly controlled diabetes and comorbid depression at these three sites and build on an National Heart, Lung and Blood Institute Center for Excellence grant established in India by Emory University. An initial one year qualitative study will help our research team adapt TEAMcare to the unique aspects of Indian culture and medical systems.
Link for TEAMcare: http://www.teamcarehealth.org/