Moving Medical Advances from Prototype into Practice

Abstract

Improving health care outcomes is difficult, and we have known for many years that successful efforts are more likely to involve a blend of approaches rather than a single “silver bullet.”1 Over the past 15 years, dozens of published trials have supported use of the multipronged “collaborative care” model as an effective strategy for improving treatment outcomes for depression2–4 as well as for a variety of other chronic medical conditions.5 Based on the Wagner Chronic Care Model, collaborative care involves active follow-up by a non-physician allied health professional “care manager” who supports patients with the time and frequency of contacts necessary to educate them about their illness and evidence-based treatment options; involves primary care physicians as active participants in their patients’ care; and proactively monitors patients’ response to therapy and suggests adjustments in care when indicated. Yet despite the proven efficacy and cost-effectiveness of this approach, collaborative care strategies have yet to be implemented widely into routine practice beyond a few large integrated health care delivery organizations.6 This lack of implementation may be due to factors ranging from the complexity, effort, and costs associated with the change (e.g., electronic medical records); reluctance by health plans to pay for new treatments and modalities of care delivery (e.g., telehealth); development of novel treatments in isolation from the real world of patient care and attention towards financial profits and losses (e.g., unbillable care manager time); lack of demand for services, particularly by patients who may be stigmatized by their condition (depression); and investigator lack of follow-through or skill with the science of implementation.7