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Valles BT, Etzler SP, Meyer JR, Kittle LD, Burns MR, Buckner Petty SA, Curtis BL, Zehring CM, Peters AL, Dangerfield BS. Development of a Complex Care Transition Team to Improve the Transition of Patients With Complex Care Needs to the Community. Prof Case Manag 2024; 29:189-197. [PMID: 38888408 DOI: 10.1097/ncm.0000000000000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
PURPOSE Health care systems have historically struggled to provide adequate care for patients with complex care needs that often result in overuse of hospital and emergency department resources. Patients with complex care needs generally have increased expenses, longer length of hospital stays, an increased need for care management resources during hospitalization, and high readmission rates. Mayo Clinic in Arizona aimed to ensure successful transitions for hospitalized patients with complex care needs to the community by developing a complex care transition team (CCTT) program. With typical care management models, patients are assigned to registered nurse case managers and social workers according to the inpatient nursing unit rather than patient care complexity. Patients with complex care needs may not receive the amount of time needed to ensure an efficient and effective transition to the community setting. Furthermore, after transitioning to the community, patients with complex care needs often do not have access to care management resources if further care coordination needs arise. PRIMARY PRACTICE SETTING Acute care hospital in the US Southwest. METHODOLOGY AND SAMPLE The CCTT was composed of a registered nurse case manager, social worker, and care management assistant, with physician advisor support. The CCTT followed patients with complex care needs during their hospitalization and transition to the community for 90 days after discharge. The number of inpatient admissions and hospital readmission rates were compared between 6 months before and after enrollment in the CCTT program. Cost savings for decreased hospital length of stay, emergency department visits, and hospital readmissions were also determined. RESULTS The CCTT selected patients according to a complex care algorithm , which identified patients who required high use of the health care system. The CCTT then followed this cohort of patients for an average of 90 days after discharge. A total of 123 patients were enrolled in the CCTT program from July 1, 2019, to April 30, 2021, and 80 patients successfully graduated from the program. Readmission rates decreased from 51.2% at 6 months before the intervention to 22.0% at 6 months after the intervention. This reduced readmission rate resulted in a cost savings of more than $1 million. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE The outcomes resulting from implementation of the multidisciplinary CCTT highlight the need for a patient-specific approach to transitioning care to the outpatient setting. The patient social determinants of health that often contributed to overuse of health care resources included poor access to outpatient specialists, difficulty navigating the health care system due to illness or poor health literacy, and limited social support. The success of the CCTT program prompted the implementation of other specialty-specific pilot programs at Mayo Clinic in Arizona. The investment of time and resources, including dedicated personnel to follow patients with high hospital service usage, allows health care systems to reduce emergency department visits and hospital admissions and to provide patients with the best opportunity for success as they transition from the inpatient to outpatient setting.
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Affiliation(s)
- Brittane T Valles
- Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Sydney P Etzler
- Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Jillian R Meyer
- Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Laura D Kittle
- Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Michelle R Burns
- Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Skye A Buckner Petty
- Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Belinda L Curtis
- Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Cathleen M Zehring
- Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Ariana L Peters
- Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Benjamin S Dangerfield
- Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
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Xiang X, Zuverink A, Rosenberg W, Mahmoudi E. Social work-based transitional care intervention for super utilizers of medical care: a retrospective analysis of the bridge model for super utilizers. SOCIAL WORK IN HEALTH CARE 2019; 58:126-141. [PMID: 30424717 DOI: 10.1080/00981389.2018.1547345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/21/2018] [Accepted: 11/08/2018] [Indexed: 06/09/2023]
Abstract
The present study was a retrospective evaluation of a social worker-led transitional care intervention that addresses the medical and social needs of inpatient super utilizers with ≥5 inpatient admissions in a 12-month period. Bivariate analyses revealed significant reductions in the total number of hospital admissions, 30-day readmission rates, number of emergency department visits, average hospital charges per episode, and total hospital charges per person after the intervention. This social work intervention may be of interest to providers and payers, particularly regarding addressing the psychosocial needs of complex patients who account for most of health care costs.
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Affiliation(s)
- Xiaoling Xiang
- a School of Social Work , University of Michigan , Ann Arbor , MI , US
| | - Ashley Zuverink
- a School of Social Work , University of Michigan , Ann Arbor , MI , US
| | - Walter Rosenberg
- b Social Work and Community Health , Rush University Medical Center , Chicago , IL , US
| | - Elham Mahmoudi
- c Department of Family Medicine , University of Michigan , Ann Arbor , MI , US
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3
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Collaborative care for the detection and management of depression among adults receiving antiretroviral therapy in South Africa: study protocol for the CobALT randomised controlled trial. Trials 2018; 19:193. [PMID: 29566739 PMCID: PMC5863840 DOI: 10.1186/s13063-018-2517-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 02/02/2018] [Indexed: 01/15/2023] Open
Abstract
Background The scale-up of antiretroviral treatment (ART) programmes has seen HIV/AIDS transition to a chronic condition characterised by high rates of comorbidity with tuberculosis, non-communicable diseases (NCDs) and mental health disorders. Depression is one such disorder that is associated with higher rates of non-adherence, progression to AIDS and greater mortality. Detection and treatment of comorbid depression is critical to achieve viral load suppression in more than 90% of those on ART and is in line with the recent 90-90-90 Joint United Nations Programme on HIV/AIDS (UNAIDS) targets. The CobALT trial aims to provide evidence on the effectiveness and cost-effectiveness of scalable interventions to reduce the treatment gap posed by the growing burden of depression among adults on lifelong ART. Methods The study design is a pragmatic, parallel group, stratified, cluster randomised trial in 40 clinics across two rural districts of the North West Province of South Africa. The unit of randomisation is the clinic, with outcomes measured among 2000 patients on ART who screen positive for depression using the Patient Health Questionnaire (PHQ-9). Control group clinics are implementing the South African Department of Health’s Integrated Clinical Services Management model, which aims to reduce fragmentation of care in the context of rising multimorbidity, and which includes training in the Primary Care 101 (PC101) guide covering communicable diseases, NCDs, women’s health and mental disorders. In intervention clinics, we supplemented this with training specifically in the mental health components of PC101 and clinical communications skills training to support nurse-led chronic care. We strengthened the referral pathways through the introduction of a clinic-based behavioural health counsellor equipped to provide manualised depression counselling (eight sessions, individual or group), as well as adherence counselling sessions (one session, individual). The co-primary patient outcomes are a reduction in PHQ-9 scores of at least 50% from baseline and viral load suppression rates measured at 6 and 12 months, respectively. Discussion The trial will provide real-world effectiveness of case detection and collaborative care for depression including facility-based counselling on the mental and physical outcomes for people on lifelong ART in resource-constrained settings. Trial registration ClinicalTrials.gov (NCT02407691) registered on 19 March 2015; Pan African Clinical Trials Registry (201504001078347) registered on 19/03/2015; South African National Clinical Trials Register (SANCTR) (DOH-27-0515-5048) NHREC number 4048 issued on 21/04/2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2517-7) contains supplementary material, which is available to authorized users.
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Fortin M, Chouinard MC, Dubois MF, Bélanger M, Almirall J, Bouhali T, Sasseville M. Integration of chronic disease prevention and management services into primary care: a pragmatic randomized controlled trial (PR1MaC). CMAJ Open 2016; 4:E588-E598. [PMID: 28018871 PMCID: PMC5173473 DOI: 10.9778/cmajo.20160031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Chronic disease prevention and management programs are usually single-disease oriented. Our objective was to evaluate an intervention that targeted multiple chronic conditions and risk factors. METHODS We conducted a pragmatic randomized controlled trial involving patients aged 18-75 years with at least 1 of the targeted chronic conditions or risk factors from 8 primary care practices in the Saguenay region of Quebec, Canada, to evaluate an intervention that included self-management support and patient-centred motivational approaches. Self-management (primary outcome) was evaluated using the Health Education Impact Questionnaire (heiQ). Secondary outcomes included self-efficacy, health-related quality of life, psychological distress and health behaviours. RESULTS Three hundred thirty-two patients were recruited and randomly assigned (n = 166 for both intervention and control groups) and evaluated after 3 months. The intervention group showed improvement in 6 of the 8 heiQ domains: health-directed behaviour (relative risk [RR] 1.71, 95% confidence interval [CI] 1.13 to 2.59), emotional well-being (RR 1.73, 95% CI 1.07 to 2.79), self-monitoring and insight (RR 2.40, 95% CI 1.19 to 4.86), constructive attitudes and approaches (RR 2.40, 95% CI 1.37 to 4.21), skill and technique acquisition (RR 1.70, 95% CI 1.14 to 2.53), and health service navigation (RR 1.93, 95% CI 1.08 to 3.47). Improvement was also observed in the Physical Component Summary (p = 0.017) and the Single Index (p = 0.041) of the 12-Item Short Form Health Survey (version 2). The intervention group improved in fruit and vegetable consumption (odds ratio [OR] 2.36, 95% CI 1.41 to 3.95) and physical activity (OR 3.81, 95% CI 1.65 to 8.76). One-year improvement was maintained in the intervention group for several outcomes. INTERPRETATION It is possible to implement an intervention integrating chronic disease prevention and management services into primary care settings. We obtained positive and promising results using this intervention. Trial registration: ClinicalTrials.gov, no.: NCT01319656.
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Affiliation(s)
- Martin Fortin
- Département de médecine de famille et de médecine d'urgence (Fortin), Université de Sherbrooke, Sherbrooke, Qué.; Département des sciences de la santé (Chouinard, Dubois), Université du Quebec à Chicoutimi, Chicoutimi, Qué.; Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean (Bélanger), Chicoutimi, Qué.; Département de médecine de famille et médecine d'urgence (Almirall, Bouhali), Université de Sherbrooke, Sherbrooke, Qué.; Facultés de Médecine et sciences de la santé (Sasseville), Université de Sherbrooke, Sherbrooke, Qué
| | - Maud-Christine Chouinard
- Département de médecine de famille et de médecine d'urgence (Fortin), Université de Sherbrooke, Sherbrooke, Qué.; Département des sciences de la santé (Chouinard, Dubois), Université du Quebec à Chicoutimi, Chicoutimi, Qué.; Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean (Bélanger), Chicoutimi, Qué.; Département de médecine de famille et médecine d'urgence (Almirall, Bouhali), Université de Sherbrooke, Sherbrooke, Qué.; Facultés de Médecine et sciences de la santé (Sasseville), Université de Sherbrooke, Sherbrooke, Qué
| | - Marie-France Dubois
- Département de médecine de famille et de médecine d'urgence (Fortin), Université de Sherbrooke, Sherbrooke, Qué.; Département des sciences de la santé (Chouinard, Dubois), Université du Quebec à Chicoutimi, Chicoutimi, Qué.; Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean (Bélanger), Chicoutimi, Qué.; Département de médecine de famille et médecine d'urgence (Almirall, Bouhali), Université de Sherbrooke, Sherbrooke, Qué.; Facultés de Médecine et sciences de la santé (Sasseville), Université de Sherbrooke, Sherbrooke, Qué
| | - Martin Bélanger
- Département de médecine de famille et de médecine d'urgence (Fortin), Université de Sherbrooke, Sherbrooke, Qué.; Département des sciences de la santé (Chouinard, Dubois), Université du Quebec à Chicoutimi, Chicoutimi, Qué.; Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean (Bélanger), Chicoutimi, Qué.; Département de médecine de famille et médecine d'urgence (Almirall, Bouhali), Université de Sherbrooke, Sherbrooke, Qué.; Facultés de Médecine et sciences de la santé (Sasseville), Université de Sherbrooke, Sherbrooke, Qué
| | - José Almirall
- Département de médecine de famille et de médecine d'urgence (Fortin), Université de Sherbrooke, Sherbrooke, Qué.; Département des sciences de la santé (Chouinard, Dubois), Université du Quebec à Chicoutimi, Chicoutimi, Qué.; Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean (Bélanger), Chicoutimi, Qué.; Département de médecine de famille et médecine d'urgence (Almirall, Bouhali), Université de Sherbrooke, Sherbrooke, Qué.; Facultés de Médecine et sciences de la santé (Sasseville), Université de Sherbrooke, Sherbrooke, Qué
| | - Tarek Bouhali
- Département de médecine de famille et de médecine d'urgence (Fortin), Université de Sherbrooke, Sherbrooke, Qué.; Département des sciences de la santé (Chouinard, Dubois), Université du Quebec à Chicoutimi, Chicoutimi, Qué.; Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean (Bélanger), Chicoutimi, Qué.; Département de médecine de famille et médecine d'urgence (Almirall, Bouhali), Université de Sherbrooke, Sherbrooke, Qué.; Facultés de Médecine et sciences de la santé (Sasseville), Université de Sherbrooke, Sherbrooke, Qué
| | - Maxime Sasseville
- Département de médecine de famille et de médecine d'urgence (Fortin), Université de Sherbrooke, Sherbrooke, Qué.; Département des sciences de la santé (Chouinard, Dubois), Université du Quebec à Chicoutimi, Chicoutimi, Qué.; Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean (Bélanger), Chicoutimi, Qué.; Département de médecine de famille et médecine d'urgence (Almirall, Bouhali), Université de Sherbrooke, Sherbrooke, Qué.; Facultés de Médecine et sciences de la santé (Sasseville), Université de Sherbrooke, Sherbrooke, Qué
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Robinson RL, Grabner M, Palli SR, Faries D, Stephenson JJ. Covariates of depression and high utilizers of healthcare: Impact on resource use and costs. J Psychosom Res 2016; 85:35-43. [PMID: 27212668 DOI: 10.1016/j.jpsychores.2016.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To characterize healthcare costs, resource use, and treatment patterns of survey respondents with a history of depression who are high utilizers (HUds) of healthcare and to identify factors associated with high utilization. METHODS Adults with two or more depression diagnoses identified from the HealthCore Integrated Research Database were invited to participate in the CODE study, which links survey data with 12-month retrospective claims data. Patient surveys provided data on demographics, general health, and symptoms and/or comorbidities associated with depression. Similar clinical conditions also were identified from the medical claims. Factors associated with high utilization were identified using logistic regression models. RESULTS Of 3132 survey respondents, 1921 were included, 193 of whom were HUds (defined as those who incurred the top 10% of total all-cause costs in the preceding 12months). Mean total annual healthcare costs were eightfold greater for HUds than for non-HUds ($US56,145 vs. $US6,954; p<.0001). HUds incurred more inpatient encounters (p<.0001) and emergency department (p=.01) and physician office visits (p<.0001). Similar findings were observed for mental healthcare costs/resource use. HUds were prescribed twice as many medications (total mean: 16.86 vs. 8.32; psychotropic mean: 4.11 vs. 2.61; both p<.0001). HUds reported higher levels of depression severity, fatigue, sleep difficulties, pain, high alcohol consumption, and anxiety. Predictors of becoming a HUd included substance use, obesity, cardiovascular disease, comorbidity severity, psychiatric conditions other than depression, and pain. CONCLUSION Focusing on pain, substance use, and psychiatric conditions beyond depression may be effective approaches to reducing high costs in patients with depression.
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Affiliation(s)
| | | | - Swetha Rao Palli
- CTI Clinical Trial and Consulting Services, Cincinnati, OH, United States
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Haroun D, Smits F, van Etten-Jamaludin F, Schene A, van Weert H, ter Riet G. The effects of interventions on quality of life, morbidity and consultation frequency in frequent attenders in primary care: A systematic review. Eur J Gen Pract 2016; 22:71-82. [DOI: 10.3109/13814788.2016.1161751] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dany Haroun
- Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands
| | - Frans Smits
- Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Aart Schene
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Henk van Weert
- Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands
| | - Gerben ter Riet
- Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands
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Carvalho IPDA, Carvalho CGX, Lopes JMC. Prevalência de hiperutilizadores de serviços de saúde com histórico positivo para depressão em Atenção Primária à Saúde. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2015. [DOI: 10.5712/rbmfc10(34)957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: estudar a associação entre história de depressão e hiperutilização de serviços de saúde (HSS) entre usuários da Atenção Primária à Saúde (APS), além de estabelecer a prevalência de HSS, o número médio de consultas e o perfil epidemiológico dos grupos com história positiva e negativa para depressão. Métodos: os dados foram obtidos de prontuários familiares de duas Unidades de Saúde. Para analisar dados sobre o desfecho primário e para comparar o perfil epidemiológico dos grupos foi utilizado o teste qui-quadrado. Para comparar a diferença na média de consultas entre os grupos, utilizou-se o teste t de student. Resultados: foram analisados 278 pacientes. As prevalências de depressão e de HSS na amostra foram, respectivamente, de 15,1 e 4,3%. Houve diferença na prevalência de HSS no grupo com história positiva para depressão, 14,3%, quando comparado ao grupo com história negativa para depressão, 2,5% (RP = 5,62, IC 95% 1,90 a 16,59, p = 0,004). A média de consultas no grupo com história positiva para depressão foi de 5,25 consultas/ano, enquanto no grupo com história negativa para depressão foi de 2,59, com diferença de médias de 2,65 (IC 95% 1,90 a 3,40; p < 0,001). Observou-se também maior prevalência de dispepsia e uso de antidepressivos entre HSS. Conclusão: os resultados reforçam dados da literatura, indicando que pessoas com histórico de depressão tendem a utilizar mais os serviços de APS, apresentando uma prevalência maior de HSS. Dessa forma, um maior conhecimento acerca do perfil dos HSS permitirá desenvolver abordagens mais resolutivas para esses usuários.
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Viksveen P, Relton C. Depression treated by homeopaths: a study protocol for a pragmatic cohort multiple randomised controlled trial. HOMEOPATHY 2014; 103:147-52. [PMID: 24685421 DOI: 10.1016/j.homp.2014.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/10/2014] [Accepted: 01/22/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The most commonly recommended treatments for depression are psychological/psychotherapeutic treatments, and antidepressant drugs. However, 38 percent of patients with depression do not use these recommended treatments. Some patients seek homeopathic treatment for depression, but insufficient evidence exists to conclude as to the effectiveness, cost-effectiveness and safety of treatment by homeopaths for patients with depression. The aim of this trial is to evaluate the acceptability and comparative clinical and cost-effectiveness of the offer of adjunctive treatment provided by homeopaths for patients with self-reported depression. METHOD This pragmatic randomised controlled trial is embedded within the population based South Yorkshire Cohort (SYC) of whom nine percent self-report long-term depression. The SYC is designed to facilitate 'cohort multiple' randomised controlled trials (cmRCT). A self-completed questionnaire will be used to both screen and collect baseline data from potential trial participants. The primary outcome is PHQ-9. One-hundred-and-sixty-two participants will be randomly selected to the intervention group (Offer of treatment by a homeopath). The results of the Offer and the No Offer groups will be compared at 6 and 12 months using both an intention to treat (ITT) and complier average causal effect (CACE) analysis. Cost-effectiveness analysis will involve calculation of quality adjusted life year (QALY). In order to help interpret the quantitative findings a selection of up to 30 patients in the offer group will be invited to participate in qualitative interviews after the first consultation and after a minimum of 6 months. Interviews will be assessed by two researchers and results will be analysed using thematic analysis. Triangulation will be used to combine results from qualitative and quantitative methodologies at the interpretation stage, to see if results agree, offer complementary information on the same issue or contradict each other.
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Affiliation(s)
- Petter Viksveen
- School of Health and Related Research, University of Sheffield, UK.
| | - Clare Relton
- School of Health and Related Research, University of Sheffield, UK
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Pfennig A, Klosterkötter J. [Check-ups and screening for young people: what is reasonable with respect to psychiatric disorders?]. DER NERVENARZT 2014; 85:1544-1550. [PMID: 25367230 DOI: 10.1007/s00115-013-3979-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Severe mental illnesses become manifested early in life. First episodes are suffered in young adulthood at the latest and early symptoms and signs are often already reported in childhood and adolescence. Therefore, it is exactly these adolescents and young adults who have to be reached to detect signs early. OBJECTIVES In this article the check-ups and screening procedures routinely offered for this target group as well as the role of groups of persons who accompany young people in a variety of contexts are illustrated. Potential extensions with elements and structures for the early recognition of severe mental illnesses are outlined. RESULTS With the integration of psychiatric peculiarities and drug consumption into the diagnostic battery of the first adolescence healthcare examination (Jugendgesundheitsuntersuchung J1), the often already established familiarity of young persons and the waiving of costs by the health insurances, the J1 seems to be well-suited to provide a rough screening for precursor stages and risk factors for the development of severe mental illnesses and for the detection of a suspected manifest mental disorder. The primary role of most persons working with young people is to be a contact partner and to help transferring the person to the adequate service. Several early recognition centers were founded in Germany to offer low-threshold contact services in the view of existing barriers to care for help-seeking young persons and to provide the complex diagnostics. CONCLUSIONS The adolescence healthcare examinations can be a useful element for early detection of mental disorders and damaging behavior if the utilization rate is high and actions taken in case of suspected beginning disorder/damaging behavior are evaluated. To date, screening instruments for psychiatric disorders should not be used in wide population classes without group-specific targets and without direct contact between therapists and patients. Already established preventive services and initiatives should be interlinked. The health effects of the actions have to be analyzed.
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Affiliation(s)
- A Pfennig
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland,
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Berghöfer A, Roll S, Bauer M, Willich SN, Pfennig A. Screening for depression and high utilization of health care resources among patients in primary care. Community Ment Health J 2014; 50:753-8. [PMID: 24449430 DOI: 10.1007/s10597-014-9700-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 01/13/2014] [Indexed: 12/31/2022]
Abstract
The study aims to evaluate the prevalence of depression and the severity of depressive symptoms among primary care patients, who are high utilizers (HU) of health care resources. A cross-sectional, two-stage design was applied to screen for depression using the Brief Psychiatric Health Questionnaire and the Diagnostic Expert System for Psychiatric Disorders. A total of 38 primary care physicians accredited to practice in Berlin and Potsdam in Germany participated in the study. A total of 1,775 patients participated, 507 were identified as HU, 182 (36%) of these were depressed compared to 81 (11%) of the typical utilizers (p < 0.001). The depression score was higher and acute suicidality was more prevalent in HU than in typical utilizers (p < 0.001). Our results suggest that HU represent a population with a high prevalence of depression in primary care and should be considered for routine depression screening.
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Affiliation(s)
- Anne Berghöfer
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, 10098, Berlin, Germany,
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Impact of mindfulness-based cognitive therapy on health care utilization: a population-based controlled comparison. J Psychosom Res 2014; 77:85-9. [PMID: 25077847 DOI: 10.1016/j.jpsychores.2014.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/14/2014] [Accepted: 06/17/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Elevated rates of mood and anxiety disorders among high utilizers of health care have been suggested as one driver of increased service use. We compared the impact of Mindfulness Based Cognitive Therapy (MBCT), a structured group treatment, on the rates of health care utilization with matched control participants receiving non-MBCT group therapy. METHODS Using Ontario health administrative data, we created a retrospective cohort of population-based patients receiving MBCT and an age- and gender-matched (3:1) cohort of non-MBCT group therapy controls. Subjects were recruited between 2003 and 2010 and stratified according to high/low rates of primary care utilization, with the high utilization cohort being the cohort of interest. The primary outcome was a reduction in an aggregate measure of non-mental health utilization comprising Emergency Department, non-mental health primary care, and non-psychiatrist specialist visits. RESULTS There were 10,633 MBCT recipients, 4851 (46%) of whom were high utilizers. The proportion of high utilizers was 13,274 (45%, N=29,795) for non-MBCT group therapy controls. Among high utilizers, there was a significant reduction in non-mental health utilization among MBCT recipients compared to non-MBCT group therapy recipients (0.55 (0.21-0.89)) suggesting that for every two MBCT patients treated, there is a reduction in 1 non-mental health visit. CONCLUSION Among high utilizers of primary care, MBCT reduced non-mental health care utilization 1year post-therapy compared to non-MBCT, group therapy controls. The reductions suggest that MBCT, an established treatment modality for a variety of mental illnesses, has the added benefit of reducing distress-related high health care utilization.
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Abstract
Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems, as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims underhealth care reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components.
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Affiliation(s)
- David E. Goodrich
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Amy M. Kilbourne
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Kristina M. Nord
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Mark S. Bauer
- Center for Organization, Leadership, & Management Research, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
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Vidler HC. Evaluation of the SHIFT-Depression® Inventory With a Sample of Australian Women, Demonstrating the Centrality of Gendered Role Expectations to Their Depression. EUROPES JOURNAL OF PSYCHOLOGY 2013. [DOI: 10.5964/ejop.v9i2.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dejesus RS, Angstman KB, Cha SS, Williams MD. Antidepressant Medication Use Among Patients with Depression: Comparison between Usual Care and Collaborative Care Using Care Managers. Clin Pract Epidemiol Ment Health 2013; 9:84-7. [PMID: 23847688 PMCID: PMC3706800 DOI: 10.2174/1745017901309010084] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 04/22/2013] [Accepted: 04/26/2013] [Indexed: 12/28/2022]
Abstract
Depression poses a significant economic and health burden, yet it remains underdiagnosed and inadequately treated. The STAR*D trial funded by the National Institute of Mental Health showed that more than one antidepressant medication is often necessary to achieve disease remission among patients seen in both psychiatric and primary care settings. The collaborative care model (CCM), using care managers, has been shown to be effective in numerous studies in achieving sustained outcomes in depression management compared to usual care. This model was adopted in a statewide depression treatment improvement initiative among primary care clinics in Minnesota, which was launched in March 2008. In this study, records of patients who were enrolled in CCM from March 2008 until March 2009 were reviewed and compared to those under usual care. Patients who were followed under the CCM had a significantly greater number of antidepressant medication utilizations when compared to those under usual care. After 6 months, mean PHQ-9 score of patients under CCM was statistically lower than those in usual care. There was no significant difference in both mean PHQ-9 scores at 6 months and antidepressant utilization between the 2 groups among patients aged 65 years and older.
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Affiliation(s)
- Ramona S Dejesus
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
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