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Find a Process to Improve: The Need for the Depression Health Disparities Collaborative

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... from Puerto Rico, Colombia, and Dominican Republic; 22% Asian, ... Massachusetts Alliance of Portuguese Speakers (MAPS) International Institute of Lowell ... – PowerPoint PPT presentation

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Title: Find a Process to Improve: The Need for the Depression Health Disparities Collaborative


1
Find a Process to Improve The Need for the
Depression Health Disparities Collaborative
  • High incidence and Prevalence of Depression in
    Lowell CHC patients despite sense that it is
    under-diagnosing
  • Diminishing Mental Health service availability in
    community.
  • Organizational objective to integrate Primary
    and Behavioral Health Services in Adult Medicine
    recognized due to co-morbidities and impact of
    behavioral health on physical health and vice
    versa
  • Desire to utilize Chronic Care Model
  • Desire to establish organizational standards or
    Depression care

2
Northeast ClusterLowell Community Health Center
  • Location Lowell, Massachusetts
  • Size 25 providers including Physicians, Nurse
    Practitioners, Midwives)
  • Programs offered Primary Care, Lab, Behavioral
    Health Services, Nutrition, Interpreting,
    Prenatal Care, Womens Services, HIV Counseling
    and Testing, HIV/AIDS Treatment, Community Health
    Education
  • Patients with Depression in 2003 782 of 8492
    Adult patients ages 18 and over, or 9.2
  • Ethnic Mix 36 Caucasian 35 Latino from Puerto
    Rico, Colombia, and Dominican Republic 22
    Asian, primarily Cambodian 5 Brazilian other
    Portuguese speaking and 7 African immigrants
    from 15 countries

3
Team Members

4
AIM STATEMENT
  • Lowell Community Health Center will redesign its
    systems, processes, and quality measurement and
    improvement approaches for Management of
    Depression in the Primary Care setting. The
    project will focus on an individual providers
    patients in the Adult Medicine clinic. The
    existing support systems and care processes will
    be analyzed and changed. This will occur by
    assessing what potential improvements can be
    piloted within each of the six key areas of the
    Chronic Care Model (health system, community,
    self-management, decision support, delivery
    system design, and clinical information systems).
    By using PDSA methodology, the health center will
    evaluate whether the piloted changes are indeed
    improvements, and will adopt those changes that
    will improve the depression management process.
    The ultimate goal is to develop a standardized
    approach to management of depression in the Adult
    Medicine clinic that can be spread to other
    providers and practice sites of the organization
    during subsequent phases of the Health
    Disparities Collaborative.

5
Population of Focus
  • Our population of focus will be all patients in
    our Internal Medicine leaders panel that have a
    primary or secondary diagnosis of depression. We
    will prospectively identify this population as we
    do not have PHQ-9 scores on existing patients.
    Entry into the project for each of the identified
    patients will be based on whether these patients
    with depression have a new episode PHQ-9 score of
    five or above (CSD population), or patients that
    have non-CSD types of depression that have a
    PHQ-9 score of five or greater. We intend to
    enter approximately 100 patients into the
    registry during phase one of the Collaborative.

6
Depression Measures
7
Senior Leadership Support
  • Executive Director initiated efforts to join
    depression collaborative, championed idea
  • Executive Director and Medical Director
    participate in Team meetings, provide direction
    encouragement
  • Adult Medicine Nurse Manager and Senior Physician
    part of team
  • Executive Director and Medical Director discussed
    need and usefulness of approach with Board
  • Board formally approved project as CQI initiative
    for CY 2005. Reports on Collaborative made at
    each Board meeting

8
Registry
  • Lowell CHC will use PECS for our registry.
  • We identified patients prospectively as they came
    through Adult Medicine.
  • Chart Abstraction was completed by Janice
    Carroll.
  • Patient data was entered into the Registry by
    Janice Carroll. Janice coordinates the day to day
    data entry updates for PECS.

9
PDSA Cycles Completed During Prework
  • Question What level of interpreter support,
    coaching and time needed for Limited English
    Proficiency (LEP) Patients to self-administer
    PHQ-9. A hunch exists that LEPs may have
    difficulty.
  • Finding All patients able to self-administer
    within 3-8 minutes with minimal coaching
    regardless of language. Depressed patients took
    longest regardless of language. Existing system
    seems to work well.

10
PDSA Cycles Completed During Prework
  • Question How much time will our Adult Medicine
    Provider need to accomplish the patient visit,
    including administration of the PHQ-9, treatment,
    and development of the Self-Care Action Plan for
    patients? Will between twenty and thirty minutes
    be enough, or must we develop a multidisciplinary
    approach so Behavioral Health Services can
    assist.
  • Finding a twenty to thirty minute slot may be
    insufficient for development of the self care
    action plan and that a multi-disciplinary
    approach will be needed that utilizes Behavioral
    Health clinicians. The provider can do the PHQ-9,
    diagnose and treat with a visit that lasts up to
    thirty minutes, but a system of care
    incorporating Behavioral Health staff to develop
    the Self-Care Action plan will be necessary.

11
Communication
  • Board of Directors was formally asked to support
    participation at a Full Board meeting in December
    2004.
  • Providers received an update at the monthly Full
    Provider meeting in December.
  • Program Managers received an update at the
    monthly Program Managers meeting in December.
  • All Staff received an update at the Quarterly All
    Staff meeting in November 2004.

12
Key Partnerships that will Help our Work in
Health Disparities
  • African Assistance Center (AAC)
  • The Cambodian Community Health Program (CCH 2010)
  • Cambodian Mutual Assistance Association (CMAA)
  • Mental Health Association of Greater Lowell
  • Lowell Transitional Living Center
  • Massachusetts Alliance of Portuguese Speakers
    (MAPS)
  • International Institute of Lowell
  • U Mass Lowell Center for Family, Work and
    Community
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