Depression "nudge"
Location
Depression screening test scores recorded as lab values in an electronic health record “nudge” primary care providers to prioritize depression care.
About You
Location
Project Street Address
16 locations in NYS
Project City
Project Province/State
New York
Project Postal/Zip Code
Project Country
United States
Your idea
Year organization founded:
1983
Year initiative began:
2004
Service/activity focus:
Other
If Service/activity focus is "other" please define in 1-2 words below:
Depression
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Project URL
Name Your Project
Depression "nudge"
Describe Your Idea
Depression screening test scores recorded as lab values in an electronic health record “nudge” primary care providers to prioritize depression care.
Innovation
What is your signature innovation, your new idea, in one sentence?
Depression screening test scores recorded as lab values in an electronic health record “nudge” primary care providers to prioritize depression care.
Describe what makes your idea unique--different from all others in the field.
The Institute uses its fully-integrated electronic health record system to facilitate the identification and treatment of depression in the context of the primary care relationship. The use of the EHR has enabled us to make depression screening and treatment a routine part of primary care across our network of 16 health centers.
While the integrated care model is gaining in popularity, the Institute’s use of the electronic health record to support its implementation has enabled us to dramatically reduce instances of untreated depression through annual, routine screening of adult patients. Though seemingly simple, the Institute’s decision to record the depression screening score as an abnormal lab value was a key innovation: since primary care providers are accustomed to responding quickly to abnormal lab values, recording the score in this way fosters an appreciation of depression as an actionable, treatable condition like any other—one that can be managed in the primary care setting.
Do you have any existing partnerships, and if so, how did you create them?
The nudge described here was the result of the collaboration between the Institute’s interdisciplinary team of staff members, including primary care providers, behavioral health staff, information technology staff and administrative staff. The Institute’s collaborative depression care model is based on the evidence-based Project IMPACT: Improving Mood, Promoting Access to Collaborative Treatment.
The Institute maintains active linkages with a number of community organizations and agencies that work with the elderly, families, adolescents, children, people with disabilities, and people needing mental health services. These numerous community partnerships help us to ensure that our services are accessible and are relevant to the needs of the communities we serve.
In which sector do these partners work? (Check all that apply)
Citizen sector (non profits, NGOs) .
Impact
Provide one sentence describing your impact/intended impact.
The Institute’s goal is to make depression screening a routine part of primary care; and make it easy for patients to access treatment.
Please list any other measures of the impact of your innovation.
Currently, nearly 75% of adult patients at Institute health centers are screened at least annually for depression. A 2006 research study of Institute patients enrolled in treatment for depression (medication, counseling, or a combination), conducted with Fordham University, found a statistically significant drop in PHQ9 (an evidence-based depression screening tool) scores between the initial visit and a three month follow-up visit, and between the three and six month follow-up visits.
One of the most profound impacts of the initiative was the cultural change among Institute primary care providers and other clinical staff unaccustomed to providing “mental health” care. “The number one thing was getting the doctors onboard, to buy into the program and recognize how it will help their patients and help the practice,” noted one staff social worker. Depression care integration has helped the Institute to promote a more holistic approach to health services delivery at our centers.
Is there a policy intervention element to your innovation?
The Institute supports changes to insurance reimbursement structures that will support full integration of behavioral health and primary care services. Fortunately, some New York State officials are advocating for increased integration of primary care and mental health services, and are seeking ways to enhance reimbursement for providers who are offer coordination of care.
How many people does your innovation serve or plan to serve? Exactly who will benefit from your innovation?
Institute health centers currently serve nearly 54,000 adult patients annually; the vast majority are low-income and have limited access to health services. By implementing routine depression screening at our health centers, we can identify patients early on, and offer them onsite treatment services that are managed collaboratively by their primary care physician, a mental health clinician, and a psychiatrist.
What is the key decision that you are trying to influence through your innovation/design?
The Institute’s innovative recording of the depression screening score as a lab value influences two key decisions. The first is the decision on the part of the primary care provider to incorporate depression care into their practice, and into the patient’s treatment plan. The second is the patient’s decision to accept and participate in treatment.
What have you learned about how people respond to your innovation/design?
We have found that a system-level support, such as the electronic “nudge” provided by the abnormal lab value, can help providers to incorporate new care processes into their practices. We have also found that involving the primary care provider, and locating behavioral health staff at the health center, greatly increases the likelihood that patients will participate in treatment for depression.
This Entry is about (Issues)
Sustainability
How is your initiative financed (or how do you expect your initiative will be financed)?
Initially, staff training, as well as the modifications to the EHR system, were financed through grant funding. Now that the model has been implemented, depression screening has become a normal part of everyday clinical activities, and is financed through ordinary patient care revenues.
Financing source
Annual budget
$46.5 million
Annual revenue generated
$46.5 million
Number of staff (full-time, part-time, volunteers)
600
What are the main financial barriers, and how do you plan to address them?
Depression screening in the primary care setting is a cost-effective way to identify patients early on, and assist them in accessing needed care in a comfortable manner. Unfortunately, treatment for depression in the primary care setting is inadequately reimbursed by insurers. The Institute hopes that successful, collaborative depression care models like ours will “nudge” insurers to increase payments for these valuable health services!
Aside from financial sustainability, how do you plan to grow and scale the initiative?
The Institute has already grown the initiative from a pilot project at one health center in the Bronx to a network-wide program implemented at each of our 16 full-time health centers in New York State. We regularly take advantage of opportunities to promote the model to the health provider community.
The Story
What was the motivation or defining moment that led to the creation of this innovation? Tell the story.
Institute health centers are located in high-need, medically underserved areas, and our patients face many barriers to accessing behavioral health services. In some communities, the social stigma attached to mental health diagnoses contributes to a reluctance to seek help. Furthermore, there is a shortage of mental health workers, particularly from minority groups.
To address this, the Institute develops models to integrate mental health care at its community health centers. In 2001, the Institute embarked on an ambitious initiative to identify and treat patients suffering from undiagnosed depression. Our goal was to make depression screening a routine part of primary care, and to facilitate a team approach to managing depression in patients.
“If it wasn't for my doctor and my therapist, I wouldn't be here today,” said a 48-year old African-American/Puerto Rican patient, who did not wish to use her name. “I lost all of my faith when my depression got the best of me, but they believed in me. They called me, got me to come to the office when I felt my worst, and as time went on, I got better.”
The Institute’s efforts to ensure that primary care providers were “on board” with the project was a key to success. Dr. Eric Gayle, medical director at the Parkchester Family Practice, where the depression care integration project was piloted, notes, “Once you start treating patients with depression, you see improvements in the rest of their well-being as well."
Please name and provide a personal bio of the social innovator behind this initiative.
Neil Calman, MD, president and CEO, is a board-certified practicing family physician, who has led the Institute since its founding in 1983. Virna Little, LCSW-r, Psy D, vice president for psychosocial services, is responsible for the delivery of mental health and social work services at all Institute health centers. Together, Dr. Calman and Ms. Little have championed integrated models of care that expand access to high-quality, comprehensive health services in medically underserved communities.
At what stage is this initiative?
Implemented with replication and scale-up.
What resources would you need to take your initiative to the next stage?
The Institute hopes that the success of this model of care will prompt increased reimbursement from insurers, which will in turn lead to wider availability of integrated care for underserved patients.
How did you hear about this contest and what is your main incentive to participate? (Confidential)
We heard about the contest from the New York City Department of Health. We are pleased to share this simple innovation with other providers to help increase access to integrated mental health care.
 | fholuba said: On May 11, 2009, the judges reviewed the entries for the Changemakers “Designing for Better Health” competition and would ... about this Competition Entry. - 962 days ago read more > |
| Depression "nudge" has been chosen as a finalist in Designing for Better Health. - 1002 days ago |
| katefahy said: (Response continued from previous message.) Chloe, to answer your question, we have found that the behavior change occurs on both the ... about this Competition Entry. - 1072 days ago read more > |
| katefahy said: Thanks for the great questions, Chloe and John. Current practices for depression screening and treatment in medical settings vary ... about this Competition Entry. - 1072 days ago read more > |
| Amelia Forrest Kaye said: Congratulations! On behalf of RWJF and the Changemakers team, we are honored to declare you a winner of the Early Entry Prize for the ... about this Competition Entry. - 1074 days ago read more > |
| chloevdc said: Hi Maxine- I actually have a similar question to that which was posed by John. For those who may be unfamiliar with how depression ... about this Competition Entry. - 1077 days ago read more > |
| John Balz said: Maxine, Correct me if I am mistaken, but this idea sounds like it fits under the category of evidence-based health care that some ... about this Competition Entry. - 1082 days ago read more > |
