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.
In an effort to increase access to mental health care in Seattle and King County, the AIMS Center at the University of Washington partnered with UW Medicine to launch the Behavioral Health Integration Program (BHIP). BHIP uses collaborative care to bring mental health treatment into all of the UW Neighborhood Clinics, a system of twelve primary care clinics located throughout greater Seattle, as well as clinics at Harborview Medical Center and the General Internal Medicine clinic at UWMC Roosevelt. Like elsewhere, mental health is a big part of primary care in Seattle and King County; in 2009, 19% of all clinic patients had a mental health diagnosis. Although Collaborative Care has been implemented around the world, the AIMS Center and UW Medicine are very proud to be able to provide it in our own community.
BHIP utilizes a web-based Care Management Tracking System that supports population-based care, provides patient outcome measures, and assists in quality improvement efforts. In October 2012, several goals were established for the BHIP program: to increase patient access by care managers and across all BHIP clinics, to improve patient outcomes on measures of depression and anxiety, to increase provider satisfaction with care management, and to improve provider satisfaction with psychiatric consultation. When measured in August 2013, the BHIP program had exceeded initial targets for each of the seven indicators.
BHIP won a Psychiatric Services Achievement Award from the American Psychiatric Association in 2014, and a Washington Award of Excellence in Healthcare Quality from Qualis Health in 2016.
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
The number of older adults is rising sharply and is expected to increase from 40.3 million to 72.1 million between 2010 and 2030. According to the Pew Research Center, 92% of adults aged 65 and older use text messaging. Despite misconceptions to the contrary, text messaging as part of primary care for older adults is growing. Text messaging holds promise as a strategy for engaging older adults in Collaborative Care depression treatment through frequent contact with a behavioral health care manager. The purpose of this research project is to develop and pilot test a text messaging intervention delivered in California primary care settings serving a patient population that is at least 25% older adults. Published research (Bao et. al. 2015) demonstrated that early follow-up contact predicts better clinical outcomes for patients. A recent analysis published by the AIMS Center (Renn et. al. 2021) showed that Collaborative Care was equally effective in older and younger adults but that older adults needed more contact with the behavioral health care manager to achieve these equivalent outcomes. Text messaging may be an effective strategy for both early and more frequent contact with patients. The AIMS Center is partnering with the Archstone Foundation on this project.
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/
More than 20 years of research evidence across more than 80 randomized controlled trials has established Collaborative Care as the integrated care approach with the most research evidence across all kinds of clinical delivery systems, patient populations, and geographic regions. This research evidence is replicated in dozens of peer reviewed publications evaluating implementation of Collaborative Care in real-world settings. Kaiser Permanente is committed to providing the highest quality care possible to their patients. They participated in the largest research trial of Collaborative Care and one of their regions has been practicing Collaborative Care for many years. The senior leaders at each of the eight regions, along with leadership from the national Mental Health and Wellness group, have made implementing Collaborative Care system-wide a key priority. The AIMS Center is partnering with them to accomplish this goal.
The Departments of Family Medicine and Psychiatry and Behavioral Sciences at the University of Washington (UW) are providing an opportunity for primary care providers to receive training and technical assistance to implement a Collaborative Care (CoCM) program or spread their existing CoCM services to enhance care for women with perinatal depression and other behavioral health disorders through the Maternal Infant Dyad – Implementation (MInD-I) Initiative, pronounced ‘mind eye’.
Participating care teams receive 15 months of technical assistance and training support from the AIMS Center, including assistance building patient screening and outcome reports for continuous quality improvement. Training will focus on helping primary care clinics to implement or enhance their CoCM programs and build sustainable staffing strategies. Training and technical assistance is not limited to perinatal populations. The AIMS Center staff and faculty are available to assist providers to build a robust CoCM program that can capably serve all patient populations. Care teams also receive free access to the AIMS Caseload Tracker over the course of their participation in MInD-I, with the option of continuing to use the registry afterwards by paying an annual hosting fee.
This project is a collaboration with the Portland Area Service Unit of the Indian Health Service (IHS) and George Fox University. George Fox University received a Health Services Resource Administration (HRSA) grant to promote integrated mental health care at two Oregon sites: the Chemawa Indian School’s Primary Care Clinic (operated by the Portland Area Service Unit) and Providence Medical Group in Newburg, OR. This project creates a learning collaborative among interested IHS and tribal clinics to implement Collaborative Care. Other clinics include the Warm Springs IHS unit and tribal clinics.
The AIMS Center is providing implementation coaching support and clinician training to support the project at the Indian Health Service and related sites.