Promoting Positive Well-Being: A Depression Prevention and Management Program
In 2007, a team of clinicians, researchers and a quality improvement professional wanted to take lessons learned from a series of CMS Special Studies in Depression (i.e., in New York, Michigan) to develop a depression prevention and management quality improvement initiative to take the good care delivered to a 324-bed SNF to a higher level.
They decided to build a depression program, which would eventually be known as the Pennsylvania Depression Collaborative. The goal of the program was to catch at-risk residents at the earliest stages (i.e., mild levels) and provide behavioral approaches based on using interventions that fostered behavioral activation and/or social support. The results of a successful 1-year pilot (n=363) are chronicled in a Provider Magazine Article.
The quality improvement model in this program which features regular interdisciplinary “Wellness Rounds” helped to maintain and gain additional improvements over a three year period. These significant findings were found across several of the CMS quality indicators based on MDS 2.0 assessment data which are known to have limited reliability.
Following these successes, the team partnered with stakeholder associations across the Commonwealth of Pennsylvania to see if the findings could be replicated in other nursing homes. An 8-month randomized control trial with 40 nursing homes (i.e., n=20 experimental group, n=20 in wait list control group) was initiated with very high retention (i.e., 36/40 homes), webinar attendance and data submission compliance. The Collaborative featured 4-Webinars (i.e., Overview, Learning Session 1, Learning Session 2 & Learning Session 3), a “smart Excel tool” modeled after those in the Advancing Excellence Campaign, and a 50-page Toolkit. Future development is currently going on in the SNF post acute short-stay setting. In this setting, the topic of depression is taught to at-risk patients who have significant symptoms of depression with the goal of better symptoms identification, prevention and management so as to both improve quality of life and reduce the risk of subsequent hospital utilization. An educational brochure is currently being trialed.
In a June, 2012 CMS Quality Measures Work Group Forum meeting, the Abramson Center for Jewish Life and its Polisher Research Institute presented draft depression measures to the work group members.
The Pennsylvania Depression Collaborative, The Abramson Center, and PRI welcome the opportunity to collaborate with individuals at research institutes and providers to expand this important work to assist residents, patients and clients in other geographic regions as well as in other healthcare settings.