New Hope for Depression Treatment

Judy Health Guide
  • Hi, everyone.  I was reading this article in today's St. Paul Pioneer Press and thought I would share it with you.  It's about results of a depression treatment initiative that tries to improve the quality of care for patients in Minnesota and surrounding states.  I felt rather excited after reading it.  It's a bit lengthy, but very impressive.


    Michael Trangle: Collaboration, measurement show startling promise for treatment of depression

    Pioneer Press

    Updated: 08/20/2009 05:49:54 PM CDT


    Clinical depression is associated with many different symptoms, but two of the most disheartening are the profound loneliness that many sufferers experience and the loss of normal initiative, energy, concentration, follow-through and just plain ability to get things done. But too often, and for too long, we have left depression sufferers alone and stuck in an awful spot.

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    Research suggests, for example, that primary care providers tend to spot major depression in only about half of those who have it. Less than half of those patients get appropriate treatment, and less than half of those are significantly better a year later. Most patients who fail to improve after their first treatment never receive another one. A large percentage of patients with depression never really finish their treatment.

    In Minnesota exciting initiatives are being implemented that have the potential to dramatically improve care.

    This is why the newly released, first-year results of a Minnesota depression treatment initiative are being received with a mix of enthusiasm and, quite frankly, some astonishment. Started in 2008 and in place at 48 primary-care clinics around the state, it's credited with helping almost half of participating depression patients make a full recovery in only six months. Treatment results show improvement up to 10 times better than the norm. This is a big deal, because a lot of people are debilitated by depression, and the majority of them can get better.

    The program is called DIAMOND (Depression Improvement Across Minnesota, Offering New Direction), and it's backed by medical groups, health plans, employers, patients and the Minnesota Department of Human Services. It's run under the auspices of the Minnesota-based Institute for Clinical Systems Improvement (ICSI) - an independent, non-profit organization that brings groups together to improve the quality of patient care in Minnesota and surrounding states.

    And why is this effort exceeding even the most aggressive "stretch" goals its creators dared to envision? In a word, it's collaboration.

    Rather than relying on a primary care provider alone, it adds a care manager who stays in touch with each patient during treatment and adds a consulting psychiatrist to the team. This extended care team has standardized, evidence-based tools to assess ongoing progress, modify treatment approaches when necessary and help the recovering patient from falling back into depression. With frequent patient contact, education and encouragement, more patients get better.

  • Second, the program relies on a new, innovative way of paying for depression care. Through ICSI, health plans and medical groups have developed a new payment model by which medical groups receive a monthly fee from health plans to cover the costs of these additional care services. It's the first, fee-for-service reimbursement system for depression care in the nation, and it allows medical groups to fund the care manager and consulting psychiatrist services described above.

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    While DIAMOND is a Minnesota innovation, nearly 40 controlled trials have shown that similar collaborative methods of managing depression in primary care improve patient health. And a recent study suggests that costs for patients involved in programs like DIAMOND for one year are actually $3,300 less over the subsequent three years than they would have been.

    And there is more collaboration happening in this area.

    A number of behavioral health clinics, agencies, and groups throughout the state are participating in a collaborative in which they learn about best practices, share their successes and learn from their failures with depressed patients. Minnesota is unique for having frontline psychotherapists and psychiatrists create systems to routinely measure whether their care is truly helping their depressed patients, agree to publicly share their results, and hold themselves accountable to improve their care.

    On a broader scale, MN Community Measurement is promoting the sharing of results for depressed patients throughout Minnesota. It has recently posted the results of depression care for 48 primary care clinics and six behavioral health clinics. We are in the early stages of working with this technically difficult measure and in some ways are still getting the bugs out. Since the results are delayed one year, the initial numbers primarily reflect baseline activities and imperfections in the measurement system. The numbers show that a state average of 4 percent of patients with depression are still being seen six months after beginning their treatment and have gotten better. That number may seem startlingly low, but it is almost identical to MN Community Measurement's starting point in establishing "best care" for diabetes. Steady improvement in diabetes care suggests similar progress is possible with other conditions.

    All the clinics that courageously volunteered and agreed to participate are pioneers who are willing to put their time, effort, energy, and reputations out there to do a better job of caring for their patients. These are the clinics to watch in the future as their patient care and scores continue to improve. Minnesotans should feel proud for supporting these creative initiatives, which are being watched nationally. This quiet Minnesota revolution must not stop here. All stakeholders - public and private, partners and competitors alike - must continue to support necessary collaboration, measurement and improvement on a sustained basis.


    Michael Trangle, M.D., is associate medical director of the behavioral health division of HealthPartners Medical Group and Regions Hospital. His e-mail address is

Published On: August 21, 2009