Early experience of a pilot intervention for patients with depression and chronic medical illness in an urban ACO

Abstract

ObjectiveThe objective was to describe the design, implementation and preliminary results of a collaborative care pilot program using hybrid colocation and centralized care management for patients with depression and chronic medical illness in an urban accountable care organization. MethodsPatients with chronic illness (diabetes mellitus, coronary artery disease and/or congestive heart failure) and comorbid depressive symptoms (Patient Health Questionnaire [PHQ]9 score ≥10) were enrolled. The interventions included collaborative care for depression and chronic conditions; behavioral support, including short-term psychotherapy by licensed clinical social worker on-site or telephonically; off-site nurse care management and psychiatrist consultation through an electronic medical record. ResultsForty-four percent of patients (n=61) achieved a depression response. In a diabetes subgroup with depression and glycosylated hemoglobin level HbA1c >8 (n=21), 33% had a depression response with a minimum 0.5% HbA1c reduction. Among a subgroup (n=25) with Framingham risk score >15% and depression, mean PHQ9 depression scores and mean Framingham scores were reduced by 35% and 34%, respectively. ConclusionsEarly experience of the pilot for multiple chronic illnesses and depression appears feasible and shows initial promise.