Abstract
Introduction: With the growing prevalence of value-based contracts, health systems are incentivized to consider population approaches to service delivery, particularly for chronic conditions like depression. To this end, UW Medicine implemented the Depression–Population Approach to Health (PATH) program in primary care (PC) as part of a system-wide Center for Medicare and Medicaid Innovation (CMMI) quality improvement (QI) initiative. Aim: To examine the feasibility of a pilot PATH program and its impact on clinical and process-of-care outcomes. Setting: A large, diverse, geographically disparate academic health system in Western Washington State including 28 PC clinics across five networks. Program Description: The PATH program was a population-level, centralized, measurement-based care intervention that utilized a clinician to provide remote monitoring of treatment progress via chart review and facilitate patient engagement when appropriate. The primary goals of the program were to improve care engagement and increase follow-up PHQ-9 assessments for patients with depression and elevated initial PHQ-9 scores. Program Evaluation: We employed a prospective, observational study design, including commercially insured adult patients with new depression diagnoses and elevated initial PHQ-9 scores. The pilot intervention group, consisting of accountable care network (ACN) self-enrollees (N = 262), was compared with a similar commercially insured cohort (N = 2527) using difference-in-differences analyses adjusted for patient comorbidities, initial PHQ-9 score, and time trends. The PATH program was associated with three times the odds of PHQ-9 follow-up (OR 3.28, 95% CI 1.79–5.99), twice the odds of a follow-up PC clinic visit (OR 1.74, 95% CI 0.99–3.08), and twice the odds of treatment response, defined as reduction in PHQ-9 score by ≥ 50% (OR 2.02, 95% CI 0.97–4.21). Discussion: Our results demonstrate that a centralized, remote care management initiative is both feasible and effective for large academic health systems aiming to improve depression outcome ascertainment, treatment engagement, and clinical care.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 333-340 |
| Number of pages | 8 |
| Journal | Journal of general internal medicine |
| Volume | 36 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2021 |
Funding
The project described was supported by Funding Opportunity Number CMS-331-44-501 from the US Department of Health & Human Services, Centers for Medicare & Medicaid Services. This funding was part of the Transforming Clinical Practice Initiative, authorized under and Social Security Act 1115(A) and in support of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to strengthen the quality of patient care and spend healthcare dollars more wisely. The project described was 100% financed with Federal Money (dollar amount $585,000). The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of the US Department of Health & Human Services or any of its agencies. Additionally, Dr. Carlo was supported by an NIH-funded post-doctoral fellowship at the University of Washington entitled “Training Geriatric Mental Health Services Researchers” (NIH project number 6T32MH073553-15).
Keywords
- care management
- depression
- measurement-based care
- population health
- quality improvement
ASJC Scopus subject areas
- Internal Medicine