Setting realistic timelines and fostering provider engagement were just two of the five factors utilized by collaborative care models that significantly improved patient outcomes, according to results published in the Journal of the American Board of Family Medicine.
“There is a wealth of research demonstrating the effectiveness of collaborative care models for patients with depression and diabetes and/or heart disease. However, these models have not been widely implemented because of various challenges, including the need for practice change, better care coordination between health and mental health professionals, financing and reimbursement for a care management model, among others,” Arne Beck, PhD, director of quality improvement and strategic research at the Kaiser Permanente Colorado Institute for Health Research, told Healio Family Medicine.
“Our study sought to identify some of these challenges across several diverse health care systems so that we could provide guidance for those systems interested in implementing this care model,” he added.
Beck and colleagues used site visit and survey data from eight Care of Mental, Physical, and Substance-Use Syndromes (COMPASS) care teams. These teams from eight health systems served 3,854 patients with a Public Health Questionnaire-9 Score of at least 10 and either:
- diabetes with HbA1c of 8% or more or systolic BP of 145 mm Hg or higher; and/or
- CVD with systolic BP of 145 mm Hg or higher.
Patients aged older than 65 years had to have both a Public Health Questionnaire-9 score greater than 10 and a systolic BP of 160 mm Hg or higher.
The care teams conducted case reviews with a consulting psychiatrist and physician weekly, reviewed a patient-tracking registry, and monitored patients’ ED and hospital use.
Five factors emerged that allowed this collaborative care model to reach its fullest potential, according to Beck.
“One, set realistic timelines. Two, foster provider engagement. Three, ensure that care management teams have the necessary skills and experience for this role. Four, determine criteria for patient enrollment in care management, and five, develop user-friendly patient tracking registries,” he said in the interview.
“We were surprised by the level of acuity, particularly the myriad of psychosocial needs, of the patients in our study,” Beck continued. “We knew they had poorly controlled depression and diabetes and/or heart disease. However, other social determinants issues arose during the care management process. This finding led us to stress the importance of assisting patients with a broader array of services outside the care setting, typically a social work function.”
He addressed family medicine doctors and primary care physicians who may be unwilling to make the change to a long-existing care model that they’ve utilized.
“The methods our health systems implemented have been shown to work in carefully controlled randomized trials. We were interested in what impediments or facilitators to implementing these methods would face across different delivery systems,” Beck said. “While we are confident that the core components of this collaborative care program are effective, the real challenge is making them work effectively in real world health care systems. Neglecting to address the various implementation barriers described in our paper would in fact decrease odds for success of the care model.”
He added the size of the study makes the findings applicable across many health care delivery systems. – by Janel Miller
Beck reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.