Collaborative Care Model Improves Physical and Mental Health

By Dani K. Dodge Medlin

Coordinating patients’ diabetes and cardiovascular treatment with mental health care can reduce depression while improving patients’ glucose and blood pressure numbers.

Kaiser Permanente Southern California and Kaiser Permanente Colorado were among the 18 medical groups that participated in a nationwide initiative called COMPASS (Care of Mental, Physical and Substance-use Syndromes). The initiative meant that enrolled patients talked at least once a month with a care manager — who worked with their primary care physician — about their depression and their medication for diabetes, hypertension or both.

And, many got better.

Of the patients with uncontrolled disease at enrollment, 40 percent achieved depression remission or response, 23 percent glucose control and 58 percent blood pressure control during an average follow-up of 11 months, according to results published this month in General Hospital Psychiatry.

“This was a successful wide-scale implementation of a collaborative care model that demonstrated it can be used in a variety of health care settings with positive effects for providers and patients,” said Karen J. Coleman, PhD, MS, Kaiser Permanente Southern California, Department of Research & Evaluation.

The Center for Medicare and Medication Innovation funded the $18-million, three-year initiative, which was implemented at 172 medical clinics within 18 medical groups across eight states. Over 3,800 patients were enrolled. The enrolled patients had diabetes or high blood pressure or both, and also had mild or moderate untreated depression.

Care managers at each clinic conducted systematic patient outreach, and regularly reviewed patient cases with a psychiatrist and primary care physician. When patients were new or not improving, the outreach to patients and the reviews were done weekly. Care managers had either behavioral health or medical training, such as social workers or nurses, but also expressed an interest in treating the patient as a whole person, rather than treating one condition at a time.

Before the COMPASS initiative began in February 2013, the collaborative model of care had already been shown to be successful in rigorous research studies. COMPASS demonstrated that the model could work in diverse medical settings, said Arne Beck, PhD, the director of Quality Improvement and Strategic Research at the Institute for Health Research at Kaiser Permanente Colorado.

The most satisfying part of implementing the initiative in Colorado was putting a new evidence-based model of care into place, and seeing it work for patients, said Dr. Beck, who was co-author on two of the four papers published this month on the COMPASS initiative and lead author on an upcoming COMPASS paper.

“Karen and I are very much translational researchers,” Dr. Beck said. “Satisfaction comes from not just seeing it in a journal, but seeing it put in to practice for the members.”

Dr. Coleman, who authored two of the four current studies on the COMPASS initiative, said the work indicates that patients with mild and moderate depression can be cared for in the primary care setting.

“Depression is a chronic disease like diabetes,” Dr. Coleman said. “Healthy behavioral changes like sleep, exercise and better eating, can improve diabetes and depression. If medications are given for depression, they can be managed in a collaborative care model just like medications for diabetes.”

One of Dr. Coleman’s papers was an overview of COMPASS that described how the collaborative model could be implemented at other medical facilities, while another examined the reactions of care managers to the new model.

“It was challenging for many care managers because there’s a lot of work in counseling patients,” she said. “But overall they had a very positive experience because they did see change in their patients — patients they had never been able to engage were able to take an active role in their own care.”