Transforming Population-Based Depression Care: a Quality Improvement Initiative Using Remote, Centralized Care Managemen
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Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA, USA; 2Department of Surgery, University of Washington, Seattle, WA, USA; 3The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA; 4UW Medicine Population Health Management, Seattle, WA, USA; 5UW Medicine, Population Health Analytics, Seattle, WA, USA; 6Health Management Associates, Seattle, WA, USA.
INTRODUCTION: With the growing prevalence of valuebased 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 differencein-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
Prior Presentations: None Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06136-y) contains supplementary material, which is available to authorized users. Received August 31, 2019 Accepted August 11, 2020
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. KEY WORDS: population health; measurement-based care; depression; quality improvement; care management. J Gen Intern Med DOI: 10.1007/s11606-020-06136-y © Society of General Internal Medicine 2020
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