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The New York State Collaborative Care Initiative: 2012–2014

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Abstract

We report on a partnership between the NYS Department of Health and Office of Mental Health that delivered the full integration of depression care into primary medical care. Called the NYS Collaborative Care Initiative (NYS-CCI), nineteen NYS academic medical centers participated. Based on principles of chronic illness care, Collaborative Care detects and manages depression in primary care using a highly prescriptive protocol (University of Washington AIMS Center website: http://uwaims.org/). Fidelity was ensured by measuring screening rates, diagnosis, enrollment, and improvement among those in treatment for 16 weeks. There was significant, progressive performance improvement in sites that served over 1 million patients over the course of the two and a half year grant. Clinics also reported satisfaction with the CC model. Based on the experience gained, we recommend a number of critical actions necessary for the successful implementation and scaling-up of CC throughout any state undertaking this endeavor.

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Notes

  1. University of Washington AIMS Center website: http://uwaims.org/.

  2. A Psychiatric Consultant supports the PCP and Care Manager in treating patients with behavioral health problems. He/she typically meets with the Care Manager weekly to review the treatment plan for patients who are new or who are not improving as expected. Between 75 and 90 % of patients are typically reviewed in this way. This kind of case review counts as a psychiatric consultation for this metric. The Psychiatric Consultant may also suggest treatment modification for the PCP to consider. This counts as a psychiatric consultation for this metric. In addition, the Psychiatric Consultant can see the patient directly. This counts as a psychiatric consultation for this metric. The numerator in this metric is meant to encompass the number of patients for which any of these 3 types of psychiatric consultation occurred.

References

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This article does not contain any studies with human participants or animals performed by any of the authors.

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All authors declare they have no conflict of interest.

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Correspondence to Lloyd I. Sederer.

Appendices

Appendix 1: Research Bibliography

Appendix 2: DOH-HMH Quarterly Reporting Metrics

See the following link for full metrics description and FAQ, http://uwaims.org/nyscci/files/MetricsSummary_FAQ.pdf.

Depression Screening: DOH-HMH

Numerator definition: Number of unique adult patients per calendar year from the outpatient site who received a PHQ-2 or a PHQ-9. This should be the number of patients with at least one screening. Patients should not be counted twice for this metric, even if they come in more than once in the year or are screened more than once in the year.

Denominator definition: All patients from the outpatient site. This should be the number of unique adult patients from the outpatient site who have had a visit within the calendar year. Patients should not be counted twice, even if they come in more than once in the year.

Enrolled Patients with Psychiatric Consult: DOH-HMH

Numerator definition: Number of unique adult patients enrolled in the Collaborative Care Initiative for which a psychiatric consultationFootnote 2 occurred this reporting period.

Denominator definition: All patients enrolled in the Collaborative Care Initiative this reporting period. This means any patient who is currently enrolled at the time of reporting.

Patients Diagnosed with Depression: DOH-HMH

Numerator definition: Number of unique adult patients screened positive from the outpatient site who were then diagnosed with depression (eliminates false positives on screen). The numerator should be the number of unique patients screened positive for depression who were also clinically diagnosed with depression during the reporting period.

Denominator definition: All patients from the outpatient site screened positive for depression. The denominator should be the number of unique patients screened positive for depression during the reporting period.

Patients Enrolled in a Physical-Behavioral Health Program: DOH-HMH

Numerator definition: Number of unique adult patients per year from the outpatient site screening positive for depression who enrolled in physical-behavioral health care coordination program (Collaborative Care Initiative). The numerator should be the cumulative number of unique patients enrolled in the program for the year.

Denominator definition: All patients from the outpatient site screened positive for depression per year. The denominator should be the cumulative number of unique patients who screened positive for depression during the year.

Patients should not be counted twice for this metric, even if they come in more than once during the year or are screened more than once during the year.

PHQ-9 Decreases Below 10 in 16 Weeks or Greater: DOH-HMH

Numerator definition: Number of unique adult patients enrolled in the Collaborative Care Initiative whose PHQ-9 went from at >10 to <10 in 16 weeks or greater.

Denominator definition: All patients enrolled in the Collaborative Care Initiative who have been in the program over 16 weeks.

Receiving Meds/Therapy after Six Months: DOH-HMH

Numerator definition: Number of unique adult patients enrolled in the Collaborative Care Initiative still receiving medication and/or psychotherapy six (6) months after enrollment. This is the number of patients still receiving depression treatment 6 months after enrollment.

Denominator definition: All patients currently enrolled in the Collaborative Care Initiative.

Monthly Progress Report Metrics

Depression Screening: Monthly Progress Report

Numerator definition: Number of unique patients seen over the reporting month who have been screened over the last year.

Denominator definition: Number of unique patients seen over the reporting month.

Patients Enrolled in a Physical-Behavioral Health Program: Monthly Progress Report

Numerator definition: Number of unique adult patients from the outpatient site screening positive for and diagnosed with depression that enrolled in the physical-behavioral health care coordination program (Collaborative Care Initiative) this reporting month. For example, for the reporting period of April 2014, in the numerator include only the number of unique patients who screened positive for and were enrolled in the care program.

Denominator definition: All unique patients from the outpatient site screened positive for and diagnosed with depression this reporting month. For example, for the reporting period of April 2014, in the denominator include only the number of unique patients who screened positive for and were diagnosed with depression in April 2014.

Retention: Monthly Progress Report

Numerator definition: Current number of unique adult patients from the outpatient site who have been enrolled in the physical-behavioral health care coordination program (Collaborative Care Initiative) for at least 12 weeks, with administrative evidence of at least three clinical contacts during the 12 weeks, at least 1 of which was in person. This means sites will need to make sure they start tracking number and type of contacts in April to be able to report on this metric accurately.

Denominator definition: Current number of unique adult patients from the outpatient site: enrolled in the physical-behavioral health care coordination program (Collaborative Care Initiative) regardless of how long they have been enrolled or the number of clinical contacts they have had.

Appendix 3: CC Essential Elements

Appendix 4: Principles of Effective Integrated Care

Appendix 5: PCPs and Collaborative Care

Appendix 6: Usual Care Versus Collaborative Care

Appendix 7: Patient Health Questionnaire (PHQ): 9 and Scoring

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Sederer, L.I., Derman, M., Carruthers, J. et al. The New York State Collaborative Care Initiative: 2012–2014. Psychiatr Q 87, 1–23 (2016). https://doi.org/10.1007/s11126-015-9375-1

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