Karen J Coleman1, Sanne Magnan2, Claire Neely2, Leif Solberg3, Arne Beck4, Jim Trevis2, Carla Heim2, Mark Williams5, David Katzelnick5, Jürgen Unützer6, Betsy Pollock7, Erin Hafer8, Robert Ferguson9, Steve Williams10. 1. Department of Research and Evaluation, Kaiser Permanente Southern California (KPSC), 100 S. Los Robles Ave., 2nd Floor, Pasadena, CA 91101-2453, USA. Electronic address: Karen.J.Coleman@kp.org. 2. Institute for Clinical Systems Improvement (ICSI), 8009 34th Ave. S., Suite 1200, Bloomington, MN 55425-1624, USA. 3. HealthPartners Institute for Education and Research (HPIER), 8170 33rd Ave. S., MS23301A, P.O. Box 1524, Bloomington, MN 55440-1524, USA. 4. Institute for Health Research (KPCO), Kaiser Permanente Colorado, P.O. Box 378066, Denver, CO 80237-8066, USA. 5. Mayo Clinic Health System, 200 First St. SW, Rochester, MN 55905, USA. 6. AIMS Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St., Box 356650, Seattle, WA 98195-6560, USA. 7. AIMS Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St., Box 356650, Seattle, WA 98195-6560, USA; Mount Auburn Cambridge IPA (MACIPA), 1380 Soldiers Field Rd., Floor 2, Brighton, MA 02135-1023, USA. 8. Community Health Plan of Washington (CHPW), 720 Olive Way, Suite 300, Seattle, WA 98101-1830, USA. 9. Pittsburgh Regional Health Initiative (PRHI), 650 Smithfield St., Centre City Tower, Suite 2400, Pittsburgh, PA 15222-3900, USA. 10. Michigan Center for Clinical Systems Improvement (Mi-CCSI), 233 E. Fulton St., Suite 20, Grand Rapids, MI 49503-3261, USA.
Abstract
OBJECTIVE: To describe a national effort to disseminate and implement an evidence-based collaborative care management model for patients with both depression and poorly controlled diabetes and/or cardiovascular disease across multiple, real-world diverse clinical practice sites. METHODS: Goals for the initiative were as follows: (1) to improve depression symptoms in 40% of patients, (2) to improve diabetes and hypertension control rates by 20%, (3) to increase provider satisfaction by 20%, (4) to improve patient satisfaction with their care by 20% and (5) to demonstrate cost savings. A Care Management Tracking System was used for collecting clinical care information to create performance measures for quality improvement while also assessing the overall accomplishment of these goals. RESULTS: The Care of Mental, Physical and Substance-use Syndromes (COMPASS) initiative spread an evidence-based collaborative care model among 18 medical groups and 172 clinics in eight states. We describe the initiative's evidence-base and methods for others to replicate our work. CONCLUSIONS: The COMPASS initiative demonstrated that a diverse set of health care systems and other organizations can work together to rapidly implement an evidence-based care model for complex, hard-to-reach patients. We present this model as an example of how the time gap between research and practice can be reduced on a large scale.
OBJECTIVE: To describe a national effort to disseminate and implement an evidence-based collaborative care management model for patients with both depression and poorly controlled diabetes and/or cardiovascular disease across multiple, real-world diverse clinical practice sites. METHODS: Goals for the initiative were as follows: (1) to improve depression symptoms in 40% of patients, (2) to improve diabetes and hypertension control rates by 20%, (3) to increase provider satisfaction by 20%, (4) to improve patient satisfaction with their care by 20% and (5) to demonstrate cost savings. A Care Management Tracking System was used for collecting clinical care information to create performance measures for quality improvement while also assessing the overall accomplishment of these goals. RESULTS: The Care of Mental, Physical and Substance-use Syndromes (COMPASS) initiative spread an evidence-based collaborative care model among 18 medical groups and 172 clinics in eight states. We describe the initiative's evidence-base and methods for others to replicate our work. CONCLUSIONS: The COMPASS initiative demonstrated that a diverse set of health care systems and other organizations can work together to rapidly implement an evidence-based care model for complex, hard-to-reach patients. We present this model as an example of how the time gap between research and practice can be reduced on a large scale.
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