By: Dr. Tom Sequist
This is the third in an ongoing series by our Quality, Safety & Value team highlighting Partners HealthCare’s efforts to develop and implement best practices across our network of hospitals to improve the quality of care patients receive while reducing costs.
Depression and related diseases have a staggering impact on our society and the U.S. economy. In 2012, approximately 7 percent of adults in the United States, or 16 million, had at least one episode of major depression. The lifetime risk of suicide for untreated depression can range as high as 15 percent. In addition, depression is a leading cause of disability for people aged 18-44 years old, and results in nearly 400 million disability days every year. In 2010 alone, depression and related diseases cost the U.S. economy over $200 billion dollars, a 21 percent increase over 2005.
As Andrew Solomon noted in his book “The Noonday Demon: An Atlas of Depression,” “Depression claims more years than war, cancer, and AIDS put together. Other illnesses, from alcoholism or heart disease, mask depression when it causes them; if one takes that into consideration, depression may be the biggest killer on earth.”
At Partners HealthCare, depression is among the five most common medical conditions that primary care physicians see and represents 10 percent of all primary care patient visits.
When it comes to identifying patients with depression, primary care doctors play a critical role. We’re working hard to help our doctors identify patients with depression as early as possible and connect them to mental health professionals, such as psychiatrists, social workers and others. Getting patients access to treatment early on also helps coordinate care and reduce overall health costs for Partners and our communities.
Patient-Reported Outcomes Program Helps Identify the Symptoms
Partners implemented the Patient-Reported Outcomes (PRO) program in 2012 to identify depression among our primary care patients. Patients take confidential surveys about their physical, social, and mental health using a computer tablet during their visit, with follow-up online or in doctors’ offices for patients who need further evaluation. Results are reported in the confidential patient medical record to help the care team focus the patient visit on the most critical issues.
The PRO survey is used by 18 medical and surgical specialties at more than 45 locations across the Partners network, and in the last year Partners surveyed nearly 70,000 patients for depression.
Collaborative Care Helps Manage Depression
In 2014, we began implementing a program within our population health management initiative to help doctors manage patients with depression and other mental health problems. Under the program, Collaborative Care, the primary care doctor and patient have the support of psychiatrists, social workers and others to help manage treatment and medication while working to prevent relapse.
In a typical primary care practice without dedicated support, medical professionals refer the patient to general community mental health resources with little feedback from patients or mental health professionals about progress treating the disease. However, under Collaborative Care, primary care physicians connect the patient to a Partners behavioral health specialist who plays an integral part in helping each physician coordinate mental health care for patients with depression. The Collaborative Care program has managed over 500 referrals from primary care doctors, and most patients who actively participate in the program see an improvement in their symptoms within a few months.
Treating Depression Is a Team Effort
Together, the Partners PRO and Collaborative Care programs provide a coordinated approach to identifying and treating depression. These programs are new, but are already providing help for patients with depression and related mental health issues.
At Brigham and Women’s at Newton Corner, doctors coordinate care for patients using the PRO and Collaborative Care programs. Dr. Reema Alshirawi, Newton Corner Medical Director, recently had a female patient complete the PRO survey. Although the patient was not planning to bring up the issues about depression, the PRO survey results showed the patient had depression and anxiety due to a recent job loss. Having identified the issues, Dr. Alshirawi then discussed the findings with the patient and worked with Collaborative Care team to help manage depression and more quickly and effectively treat the patient.
Dr. Alshirawi believes the two Partners programs are critical to starting the conversation about patient mental health in the doctor’s office. “Patients do not always make an appointment to see a doctor about their mental health or may think their symptoms are not important, and doctors do not always have as much time as they would like to discuss all patient issues. However, the PRO and Collaborative Care programs help make it possible for me to address more of my patient’s problems so I can treat the whole person,” noted Dr. Alshirawi.
Coordination between these programs and doctors is showing results. For example, since early 2014, Newton Corner has surveyed over 2,300 patients, followed 80 patients closely, and connected 30 patients to a mental health specialist.
Caring for Patients with Depression in the Future
These two programs are just beginning to take hold. We plan to expand PRO throughout our hospitals and community sites while adding additional medical and surgical conditions, and expect to roll out Collaborative Care to adult primary care practices across the network over the next couple of years. The overall goal is to closely connect all doctors’ offices with help to identify and treat patients with depression as early and efficiently as possible while improving patients’ lives and reducing costs throughout the healthcare system.
Read our last post in the "Higher-Quality Care" series.