A collaborative care program that incorporates mental health treatment and screening into primary care has helped the country's largest public healthcare system improve depression symptoms in more than half of enrolled patients, according to a blog post for NEJM Catalyst.
New York City Health + Hospitals set out to redesign care to screen and treat patients for depression across its integrated system of hospitals, healthcare centers, nursing homes and home care, while allowing patients to remain within their primary care medical home, according to the authors, who all work for the health system.
Two years ago the system began to conduct annual screenings of all adult primary care patients for depression using a questionnaire to help physicians identify potential cases of depression in people who are unlikely to seek mental health care on their own. The system then expanded the screenings to each patient visit.
At the same time, the system launched a collaborative care program to treat identified patients at 11 hospitals and six community health centers, according to the post. Each patient flagged in the screening process then meets with a depression clinician and is added to a system-wide collaborative care registry, which helps generate data to support patient outreach and promote effective treatment workflows, the authors write.
Since implementing the program, the system has identified nearly 15,000 patients who may have symptoms of depression and reports that its clinical improvement rate went from 17.7 in 2015 percent to 57.6 percent in the first quarter of 2016.
The authors identified three core practices than can help drive positive outcomes for hospitals that want to pilot similar programs:
- Identify staff who may need coaching on accurate use of the screening questionnaire
- Provide a "warm hand-off" between the primary care physician and depression clinician
- Use the registry to monitor patients who may fall through the cracks
To learn more:
- read the blog post