NYC Health + Hospitals Reduced Depression Symptoms of Patients Screened and Treated by Primary Care Teams
Case study in NEJM Catalyst showcases successful program that integrates mental and physical health of patients
Jun 28, 2016
NYC Health + Hospitals, the nation’s largest public health care delivery system, helped reduce depression symptoms among more than half of patients enrolled in an innovative program that integrates medical and mental health care and allows patients diagnosed with depression to receive the care and support they need in their primary care medical home. The clinical improvements were reported in a case study published by NYC Health + Hospitals leaders in NEJM Catalyst, an online publication from the New England Journal of Medicine.
In March 2016, 57.6 percent of patients enrolled in the health system’s Collaborative Care for Depression program indicated improvements in their PHQ-9 test results, a screening tool that monitors the severity of depression based on patients’ mood, ability to concentrate during daily tasks, energy level, appetite and sleep patterns. One year earlier, only 17.7 percent had indicated improved PHQ-9 rates. In 2015, 15,000 patients screened positive for depression symptoms.
“By making depression screening part of routine medical care we are able to identify patients with untreated depression who would not have sought out mental health services because they were not properly diagnosed or due to stigma, lack of access to care or financial constraints,” said Dr. Ram Raju, President and CEO, NYC Health + Hospitals. “This innovative approach that integrates medical and mental health into the primary care setting is a critical step to improving the mental wellness of New York City. I commend the work of the Collaborative Care team for creating a model of care catering to our most vulnerable patients.”
“One in five New Yorkers suffers from mental illness and approximately 8 percent of adult New Yorkers experience symptoms of depression each year. This team-based approach puts the needs of our patients first and successfully connects them to the health care they need.” said Dave A. Chokshi, MD MSc, senior author of the published case study and Assistant VP of the Office of Ambulatory Care Transformation.
The NYC Health + Hospitals Collaborative Care for Depression program was implemented at the 11 public hospitals and six community health centers. Patients who screen positive on the PHQ-9, are diagnosed with depression by a physician, and meet eligibility requirements are referred to the program. They were monitored closely under a system-wide patient registry, and remain receiving care and treatment with their primary care doctor. As symptoms of depression improved, intensity of the Collaborative Care treatment decreased.
The case study is featured on NEJM Catalyst, an online publication for health care executives, clinician leaders, and clinicians to share innovative ideas and practical applications for enhancing the value of health care delivery. The case study authors outlined the following key components for success:
- It is possible to screen for and treat depression in the primary care setting;
- Collaborative Care for depression can succeed in diverse settings with a range of staffing combinations, patient demographics, and physical layouts;
- Centralized data support is essential to drive operational workflows and quality improvement across multiple sites.
Funding for the Collaborative Care for Depression program was made possible by a grant from the New York State Office of Mental Health and has since been sustained through funding from New York’s Medicaid program.
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About NYC Health + Hospitals
NYC Health + Hospitals is the largest public health care system in the nation with a network of 11 hospitals including six regional trauma centers, community-based health centers, nursing homes, post-acute care centers, and a correctional health services unit. The system includes a home care agency and a health plan, MetroPlusHealth. The health system provides essential services to 1.2 million New Yorkers every year in more than 70 locations across the five boroughs. Its diverse workforce of more than 42,000 employees are uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible. Visit nychealthandhospitals.org and stay connected: https://www.facebook.com/NYCHealthSystem/ or Twitter @NYCHealthSystem.