Collaborative Care, Community C-L
Collaborative Care (CoCM) is an evidence-based model for the treatment of common behavioral health (BH) conditions, such as depression, in the primary care setting. It emphasizes key population health principles (e.g., patient registries and measurement-based care) and hinges on systematic collaboration between the primary care provider, a designated psychiatric consultant and a specially trained behavioral health care manager (BHCM). Although CoCM has been successfully adapted worldwide and has been found to be effective by more than 80 randomized controlled trials (RCTs), there have been far fewer formal evaluations of implementations in community, rural and lower-resource settings. In an attempt to reduce this gap in the literature, the authors have conducted a longitudinal, pragmatic evaluation of CoCM outcomes from more than 130 clinics (65% of which are Federally Qualified Health Centers (FQHCs)) providing CoCM services for 35,000 patients across seven states. The results of this investigation demonstrate patterns in clinic-level CoCM outcome variation and provide realistic and attainable benchmarks for depression outcomes based on key clinic- and patient-level demographic factors. This benefits clinics and health systems nationwide by providing outcome targets based on “real-world” data instead of RCT results with less external validity. Additionally, the findings of this study demonstrate the importance of clinical outcome measurement using evidence-based instruments (e.g., PHQ-9) and show that outcome metric definitions for depression improvement can significantly impact clinic-level performance. This is noteworthy because the current lack of outcome metric standardization makes it challenging to compare the results of CoCM evaluations across organizations and studies, a significant obstacle for policymakers.
This session will be divided into four primary sections. First, Drs. Jürgen Unützer and Anna Ratzliff will discuss the context of the investigation, including the sources of data and the involvement of the University of Washington in the implementation of CoCM at the included organizations (20 minutes). Next, Dr. Unützer will outline key study results and demonstrate patterns in CoCM outcome variation across diverse clinics and patients (20 minutes). Dr. Andrew Carlo will then discuss the importance of depression clinical outcome measurement and demonstrate how clinic-level performance varies significantly with outcome metric definitions. He will specifically show how changes in metric definitions can alter clinic-level CoCM outcome “rankings” (20 minutes). Finally, Drs. Unützer and Ratzliff will demonstrate a publicly available tool created by researchers at the University of Washington that uses statistical modeling methods to provide clinics the opportunity to input their own data and receive customized CoCM outcome benchmarks (20 minutes). The session will conclude with an interactive question-and-answer session for attendees (10 minutes).