MANKATO CLINIC LAUNCHES DIAMOND INITIATIVE TO ENHANCE TREATMENT OF PATIENTS WITH DEPRESSION
As part of Mankato Clinic’s commitment to its patient-centered healthcare home model, the clinic will take the model a step further by focusing on patients with depression and launching the DIAMOND initiative, at its North Mankato Family Practice and Wickersham Family Practice locations this month. Mankato Clinic is the only clinic in the region to offer DIAMOND services at this time.
DIAMOND, or Depression Improvement Across Minnesota, Offering a New Direction, is a new model for treating patients with depression in primary care by taking a team approach. It was developed in 2008 by the Institute of Clinical Systems Improvement (ICSI). ICSI is a non-profit organization that works with medical groups, hospitals, health plans, purchasers, policy makers and consumers to deliver patient-centered and value-driven health care services in Minnesota and its surrounding areas. Mankato Clinic is a member of ICSI and is part of the fourth group of clinics in Minnesota and Wisconsin to participate in the DIAMOND initiative.
“At Mankato Clinic, we sought a more effective way of providing depression care that takes the sole responsibility away from the primary physician and expands it to a team of care providers with the patient at the center,” said Julie Gerndt, chief medical officer at Mankato Clinic. “By taking a collaborative approach and integrating care managers and medical health professionals into primary care, outcomes of patients with depression are significantly improved compared to results seen under the standard care.”
DIAMOND helps overcome barriers to successful depression treatment in primary care clinics. It offers a scientifically-sound framework and training program to establish evidence-based, collaborative, measurable and actionable solutions.
There are six components of the DIAMOND model that distinguish it from traditional depression care including:
• A validated screening tool or checklist that helps the health care team detect and manage symptoms of depression
• A way for the care team to regularly track patient progress
• A proven medical guide with stepped-care approach for treatment modification or intensification
• A relapse prevention plan with tools to keep a patient who is improving from relapsing and move them out of the care management program
• A care manager to educate, coordinate and troubleshoot depression services and who serves as a liaison between psychiatrist, primary care provider and patient
• A consulting psychiatrist who reviews patient cases with the care manager and may consult with the primary care physician
Barb Anderson, CGRN, Quality Management specialist and DIAMOND initiative project manager at Mankato Clinic, says the use of a care manager is an important aspect of DIAMOND. “The involvement of the care manager is integral to the success of the initiative,” said Anderson. "The care manager has special training and works together with the patient to best support their depression treatment needs." Typically, a care manager has a nursing or mental health care background; and in collaboration with the entire health care team, is responsible for education, self management support, primary care mental health care coordination and relapse prevention.
The consulting psychiatrist collaborates with the care manager and reviews the clinic’s DIAMOND patient caseload weekly and recommends changes in treatment for patients not improving. The primary care physician makes all final treatment decisions and initiates changes in treatment plans. “If we are not getting desired outcomes and the patient is not making progress at certain steps, we get additional care providers involved,” said Gerndt. “It has proven effective just by changing the model of care.”
After tracking patients who followed DIAMOND care for 12 months, ICSI states remission rates were 49 percent surpassing goals by 19 percent and response rates, or the decrease in the severity of depression, were 72 percent exceeding goals by 22 percent.
According to ICSI, more than 37 DIAMOND trials have shown this method improves patient health. Patients had more depression-free days, fewer suicidal thoughts, stated they felt better physically and liked the care they received more. Employers benefited also because patients missed fewer days of work and were happier and more productive at work. And, health care costs decreased compared to costs under usual primary care.
DIAMOND also offers the Clinic an opportunity to enhance treatment models of other chronic diseases that are typically difficult to treat. “Depression is the first specific chronic disease that we have expanded our medical home model into,” said Gerndt. “We are excited and encouraged by the results of other clinics who have implemented DIAMOND. We hope to replicate those outcomes and expand the model to other Mankato Clinic sites as well as use DIAMOND to develop a model of care for other chronic diseases.”