Correct me if I am mistaken, but this idea sounds like it fits under the category of evidence-based health care that some medical professionals and economists are hoping to build on. Could you explain to me more about how screening for depression usually works and what kind of biases in judgment are made? Is your idea more accurate? Does it save time? What kinds of feedback mechanisms can you build into procedures for displaying and using the depression screening score so that it will not be easily ignored?
John
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John Balz
Changemakers Featured Commentator
I actually have a similar question to that which was posed by John. For those who may be unfamiliar with how depression issues are currently handled in doctor's offices, can you explain a bit about what the standard practice is and how this is different? Also, I assume the behavior change then happens with the doctors more than the patients. Is that true?
This sounds very promising and I'm excited to learn more!
Thanks for the great questions, Chloe and John. Current practices for depression screening and treatment in medical settings vary widely, and there is not one clear standard. Traditionally, there has been a divide between “medical” and “mental” health care, and this plays out in all kinds of ways. Providers may or may not feel equipped, or be willing, to recognize depression in their patients. Patients may not be inclined to report symptoms of depression to their medical doctor, because of embarrassment, fear, or because they don’t know if it is an appropriate topic to bring up with their doctor. Patients may speak up about “medical” symptoms like fatigue, insomnia, or chronic pain, but not report feelings of sadness or hopelessness.
That paradigm is now shifting, thanks to a number of individuals and institutions who are advocating for, and implementing, integrated service delivery. Some of these models are indeed evidence-based: the one we are most familiar with is the IMPACT model, which the Institute piloted at its Bronx health centers a few years ago, to great success. But there are lots of folks across the country who are working to diminish the stigma associated with a “mental health” diagnosis, and increase access to effective treatments. Access to depression care in the primary care setting is especially important because for most people, the primary care office is their “entry point” to the health care system. Routine screening in the context of primary care could prevent many patients with depression from slipping through the cracks.
Chloe, to answer your question, we have found that the behavior change occurs on both the patient and provider levels. Though they may not raise the subject themselves, patients are generally willing to report symptoms of depression if they are specifically asked about them. This is why regular, routine screening is so important: it “nudges” the patient to consider that depressive symptoms are a health concern, and are treatable. The Institute for Family Health's signature innovation (recording a high depression screening score as a “lab value” in the electronic health record) tackles the other side, and is oriented towards the providers. Even providers who feel well-equipped to identify and treat depression in their patients benefit from the “nudge” of the lab value, because it mimics the way they track and respond to patients’ other needs. It puts depression in the realm of other, more familiar, concerns. For example, elevated cholesterol levels are also recorded as abnormal lab values in the EHR, and providers know immediately how to respond to this clinical information. The Institute’s “depression nudge” is fostering that same capacity with depression screening scores, so that we can provide better care to patients experiencing depression.
The other advantage of recording the screening scores as lab values is that we can then use the EHR to graph the scores over time, and to generate reports (for example, a phone list of patients with high screening scores who have not had a follow-up visit) . This makes it easy for providers to see how patients are doing, and to coordinate outreach to at-risk patients. John, I think this gets at your question as to how we’ve been able to use the “depression nudge” to give feedback to providers, and make sure we don’t ignore the screening results.
I hope I’ve answered your questions—thanks again for the great feedback!
Congratulations! On behalf of RWJF and the Changemakers team, we are honored to declare you a winner of the Early Entry Prize for the “Designing for Better Health” collaborative competition! As a reward, you will receive a camcorder and a digital camera!
We hope that by submitting your innovation early, you have been able to generate feedback, dialogue, and insight about your initiative. Showcasing your blueprint and the challenges involved in creating social impact advises potential investors about how best to improve funding/investing patterns for the sector and to maximize the strategic impact and effectiveness of their future investments.
Please remember that your selection as an Early Entry Prize winner does not preclude you from winning the competition in any way, or guarantee finalist status—all entries will be equally evaluated per the Changemakers criteria at the completion of the entry period.
Congratulations, again!
Best wishes,
The Changemakers Team
----------
The Changemakers Team
Ashoka's Changemakers
On May 11, 2009, the judges reviewed the entries for the Changemakers “Designing for Better Health” competition and would like to pass on the following feedback (listed below) for your entry. Thank you for applying and for your hard work in the field. We are excited to archive your entry to serve as a leading solution for the worldwide community of innovators who are seeking solutions that help people make better choices regarding their health and the health of others. We wish you continued luck with your innovative, sustainable, and socially impactful initiatives.
All the best, The Changemakers Team
“ Good example of data-driven medicine. But if insurance companies don’t fully reimburse physicians and patients for mental health costs will your program still be able to gain traction? Also, can you provide more information about the rigor in which the algorithm works within the referral process? If this is included as an option, could it lead to over-diagnosis?”
“Interesting idea with demonstrated impact, has already scaled up to involve all clinics in their system. A lot happens in a medical visit and doctors don’t always take into account that depression is under diagnosis.”
- Changemakers “Designing for Better Health” Judges: Doutores da Alegria, The Robert Wood Johnson Foundation, Cornell Food and Brand Lab: Cornell University, Innovations in Health @ Massachusetts Institute of Technology, Department of Pediatrics: University of California San Francisco.
Comments
Maxine,
Correct me if I am mistaken, but this idea sounds like it fits under the category of evidence-based health care that some medical professionals and economists are hoping to build on. Could you explain to me more about how screening for depression usually works and what kind of biases in judgment are made? Is your idea more accurate? Does it save time? What kinds of feedback mechanisms can you build into procedures for displaying and using the depression screening score so that it will not be easily ignored?
John
----------
John Balz
Changemakers Featured Commentator
Hi Maxine-
I actually have a similar question to that which was posed by John. For those who may be unfamiliar with how depression issues are currently handled in doctor's offices, can you explain a bit about what the standard practice is and how this is different? Also, I assume the behavior change then happens with the doctors more than the patients. Is that true?
This sounds very promising and I'm excited to learn more!
Thanks!
-Chloe Feinberg
Ashoka
Full Economic Citizenship
Thanks for the great questions, Chloe and John. Current practices for depression screening and treatment in medical settings vary widely, and there is not one clear standard. Traditionally, there has been a divide between “medical” and “mental” health care, and this plays out in all kinds of ways. Providers may or may not feel equipped, or be willing, to recognize depression in their patients. Patients may not be inclined to report symptoms of depression to their medical doctor, because of embarrassment, fear, or because they don’t know if it is an appropriate topic to bring up with their doctor. Patients may speak up about “medical” symptoms like fatigue, insomnia, or chronic pain, but not report feelings of sadness or hopelessness.
That paradigm is now shifting, thanks to a number of individuals and institutions who are advocating for, and implementing, integrated service delivery. Some of these models are indeed evidence-based: the one we are most familiar with is the IMPACT model, which the Institute piloted at its Bronx health centers a few years ago, to great success. But there are lots of folks across the country who are working to diminish the stigma associated with a “mental health” diagnosis, and increase access to effective treatments. Access to depression care in the primary care setting is especially important because for most people, the primary care office is their “entry point” to the health care system. Routine screening in the context of primary care could prevent many patients with depression from slipping through the cracks.
(Response continued in next message.)
(Response continued from previous message.)
Chloe, to answer your question, we have found that the behavior change occurs on both the patient and provider levels. Though they may not raise the subject themselves, patients are generally willing to report symptoms of depression if they are specifically asked about them. This is why regular, routine screening is so important: it “nudges” the patient to consider that depressive symptoms are a health concern, and are treatable. The Institute for Family Health's signature innovation (recording a high depression screening score as a “lab value” in the electronic health record) tackles the other side, and is oriented towards the providers. Even providers who feel well-equipped to identify and treat depression in their patients benefit from the “nudge” of the lab value, because it mimics the way they track and respond to patients’ other needs. It puts depression in the realm of other, more familiar, concerns. For example, elevated cholesterol levels are also recorded as abnormal lab values in the EHR, and providers know immediately how to respond to this clinical information. The Institute’s “depression nudge” is fostering that same capacity with depression screening scores, so that we can provide better care to patients experiencing depression.
The other advantage of recording the screening scores as lab values is that we can then use the EHR to graph the scores over time, and to generate reports (for example, a phone list of patients with high screening scores who have not had a follow-up visit) . This makes it easy for providers to see how patients are doing, and to coordinate outreach to at-risk patients. John, I think this gets at your question as to how we’ve been able to use the “depression nudge” to give feedback to providers, and make sure we don’t ignore the screening results.
I hope I’ve answered your questions—thanks again for the great feedback!
Congratulations! On behalf of RWJF and the Changemakers team, we are honored to declare you a winner of the Early Entry Prize for the “Designing for Better Health” collaborative competition! As a reward, you will receive a camcorder and a digital camera!
We hope that by submitting your innovation early, you have been able to generate feedback, dialogue, and insight about your initiative. Showcasing your blueprint and the challenges involved in creating social impact advises potential investors about how best to improve funding/investing patterns for the sector and to maximize the strategic impact and effectiveness of their future investments.
Please remember that your selection as an Early Entry Prize winner does not preclude you from winning the competition in any way, or guarantee finalist status—all entries will be equally evaluated per the Changemakers criteria at the completion of the entry period.
Congratulations, again!
Best wishes,
The Changemakers Team
----------
The Changemakers Team
Ashoka's Changemakers
On May 11, 2009, the judges reviewed the entries for the Changemakers “Designing for Better Health” competition and would like to pass on the following feedback (listed below) for your entry. Thank you for applying and for your hard work in the field. We are excited to archive your entry to serve as a leading solution for the worldwide community of innovators who are seeking solutions that help people make better choices regarding their health and the health of others. We wish you continued luck with your innovative, sustainable, and socially impactful initiatives.
All the best, The Changemakers Team
“ Good example of data-driven medicine. But if insurance companies don’t fully reimburse physicians and patients for mental health costs will your program still be able to gain traction? Also, can you provide more information about the rigor in which the algorithm works within the referral process? If this is included as an option, could it lead to over-diagnosis?”
“Interesting idea with demonstrated impact, has already scaled up to involve all clinics in their system. A lot happens in a medical visit and doctors don’t always take into account that depression is under diagnosis.”
- Changemakers “Designing for Better Health” Judges: Doutores da Alegria, The Robert Wood Johnson Foundation, Cornell Food and Brand Lab: Cornell University, Innovations in Health @ Massachusetts Institute of Technology, Department of Pediatrics: University of California San Francisco.
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