National initiative finds collaborative care effective for patients with depression and diabetes or cardiovascular disease

BLOOMINGTON, Minnesota — Depression and diabetes were two challenges Carolyn Berry of Denver, Colorado faced when she first entered the COMPASS (Care of Mental, Physical and Substance-use Syndromes) initiative. COMPASS was a large-scale multisite collaborative care model for patients with depression and diabetes and/or cardiovascular disease. With the help of a care coordinator calling her and helping her through her depression and a care coordinator monitoring her medication use over the phone, Berry saw marked improvement in her depression symptoms.

“I think it is the most fabulous program they ever had,” said Berry. “It was such a help for me. I didn’t have to force myself to make an appointment. The phone calls just came. She (a care coordinator) would call every couple of weeks. I just think the phone part of the whole program was ideal. It would be good for thousands of people like me who wouldn’t take the time to make an appointment.”

The COMPASS initiative was conducted in 172 clinics representing 18 different medical groups across eight states from February 2013 to March 2015. Findings are released in the latest issue of General Hospital Psychiatry. Copies of this paper are available to credentialed journalists upon request; please contact Elsevier’s Newsroom at newsroom@elsevier.com or +31 20 485 2492.

COMPASS involved implementing a systematic way to care for medically complex patients. Care managers at clinics helped keep people from falling through the cracks. Care managers conducted systematic outreach, and reviewed patient cases in weekly consultations with a psychiatrist and primary care doctor when patients were not improving.

“Complex patients with both depression and diabetes or heart disease are more likely to have their diseases improved or controlled through an initiative like COMPASS,” said Leif Solberg, HealthPartners Institute investigator.

The Center for Medicare and Medication Innovation funded the initiative with $18 million over three years. Over thirty-eight hundred patients were part of the report, including patients with a wide variety of income levels and care systems. HealthPartners Institute led the monitoring, performance reporting, and assessment of the initiative’s implementation and outcomes. Institute for Clinical Systems Improvement (ICSI) provided direct implementation coaching and support, including development of an implementation guidebook. The Advancing Integrated Mental health Solutions (AIMS) Center at the University of Washington led the patient registry and outcomes reporting for COMPASS.

“There is very little research on the institutionalization of effective approaches to chronic disease management in large health care systems,” said Karen Coleman, PhD, Kaiser Permanente Southern California, Department of Research & Evaluation. “Our findings from the COMPASS initiative provide a roadmap for others to use when implementing evidence-based collaborative care programs in real-world clinical settings. In our own institution, COMPASS instigated a sea change for thinking about the treatment of depression in primary care settings and has led to wide-scale infrastructure changes in order to provide collaborative care for depression.”

“Many health care programs focus on single diseases. The COMPASS focus on integrating care for both behavioral health conditions and medical conditions, in partnership with a patient’s primary care physician, is an effective way to help patients achieve multiple health goals,” said Claire Neely, Chief Medical Officer, ICSI.

The COMPASS model results showed that of those with uncontrolled disease at enrollment, 40% achieved depression remission or response, 23% glucose control and 58% blood pressure control during an average follow-up of eleven months.

Rebecca Rossum, MD, an investigator at HealthPartners Institute, added, “COMPASS demonstrates that an evidence-based collaborative care model can be effectively implemented across diverse systems to successfully treat medically complex patients with uncontrolled disease. In this sense, COMPASS may serve as a model for future real-world collaborative care implementation.”