Early experience of a pilot intervention for patients with depression and chronic medical illness in an urban ACO

Objective: The objective was to describe the design, implementation and preliminary results of a collaborative care pilot program using hybrid colocation and centralized care management for patients with depression and chronic medical illness in an urban accountable care organization. Methods: Patients with chronic illness (diabetes mellitus, coronary artery disease and/or congestive heart failure) and comorbid depressive symptoms (Patient Health Questionnaire [PHQ]9 score ≥ 10) were enrolled. The interventions included collaborative care for depression and chronic conditions; behavioral support, including short-term psychotherapy by licensed clinical social worker on-site or telephonically; off-site nurse care management and psychiatrist consultation through an electronic medical record. Results: Forty-four percent of patients (n=61) achieved a depression response. In a diabetes subgroup with depression and glycosylated hemoglobin level HbA1c > 8 (n=21), 33% had a depression response with a minimum 0.5% HbA1c reduction. Among a subgroup (n=25) with Framingham risk score > 15% and depression, mean PHQ9 depression scores and mean Framingham scores were reduced by 35% and 34%, respectively. Conclusions: Early experience of the pilot for multiple chronic illnesses and depression appears feasible and shows initial promise.