Comparing Implementation Models Across Two Kaiser Permanente Regions to Improve Outcomes for Patients With Comorbid Depression and Diabetes
collaborative care, depression
Background/Aims: The Care for Mental, Physical, and Substance-use Syndromes (COMPASS) initiative was funded by the Centers for Medicare & Medicaid Services (CMS) to implement collaborative care in primary care settings for patients with comorbid depression and diabetes, coronary artery disease and/or substance-use disorders. Here we compare implementation strategies in Kaiser Permanente Colorado (KPCO) and Southern California (KPSC) to inform potential dissemination strategies across other HMO sites.
Methods: COMPASS patients are enrolled if they have PHQ9 scores > 10 and poorly controlled diabetes (HbA1c > 8.0). The proposed collaborative care model requires a team with a consulting psychiatrist, consulting physician and care manager. The care manager provides both behavioral health interventions and medical care, and facilitates a weekly structured case review to determine treatment intensification. The program lasts at least six months with six months of maintenance. COMPASS implementation at KPCO included a dedicated, centralized nurse care manager and therapist working together who telephonically outreached and followed patients. COMPASS implementation at KPSC used an existing depression care management program in primary care at four medical center service regions, requiring care managers to change their scope of practice to address diabetes. Both KPCO and KPSC held weekly structured case reviews. KPCO was centralized and KPSC was done by teams at each participating medical center.
Results: The initiative began in 2012. To date, KPCO has enrolled 303 patients and KPSC 712. Remission rates for depression are 26% in KPCO and 39% in KPSC patients. Control rates for diabetics are 39% for KPCO and 38% for KPSC.
Discussion: Centralized care management may increase uniformity and fidelity of implementation, but limit reach and compromise outcomes without additional local primary care support. Conversely, adding care management tasks to existing staff may increase reach but attenuate outcomes without adequate staff training in co-management of psychological and medical care needs. Funded by the U.S. Department of Health and Human Services via CMS (#1C1CMS331048-01-00), the contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.
Dreskin M, Beck A, Beaubrun GF, Brace NE, Aunskul A, Boggs JM, Coleman KJ. Comparing Implementation Models Across Two Kaiser Permanente Regions to Improve Outcomes for Patients With Comorbid Depression and Diabetes. J Patient Cent Res Rev 2015;2:93-94. http://dx.doi.org/10.17294/2330-0698.1090