Incorporating Care Managers to Improve Care
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Lancaster General Health
Lancaster County, Pennsylvania
Depression
FQHCs and hospital-based outpatient practices
Minority women |
PROJECT
Patients at risk of perinatal depression receive the services of a care manager.
Lancaster General Health trains and incorporates site-specific care managers into established systems of perinatal depression care with the goal of improving depression care for low-income, minority women. Pregnant women with a high risk of depression who receive a diagnosis of a major depressive episode are provided with the services of a trained care manager. The goal of the project is to initiate evidence-based treatment of depression within one month of diagnosis of a major depressive episode. The care managers provide culturally competent and linguistically appropriate support for the patient. They also connect patients with the health care system and serve as coaches, collaborators and negotiators on behalf of patients. Two Federally Qualified Health Centers (FQHCs) and two hospital-based outpatient practices that provide care to Medicaid patients are participating.
RATIONALE
In addition to the negative effects of perinatal depression on women of all backgrounds and their families, lowincome minority women in particular often receive poor-quality depression services and fail to receive culturally and linguistically appropriate services. Care managers are trained to provide important linkages between patients and providers, reinforce care messages, support disease self-management, and help connect patients to community resources.
This intervention aims to improve the timely diagnosis and initiation of treatment for major depression and the continuity of care for depression across the transition of care from pregnancy to postpartum. Care managers provide linguistically and culturally appropriate advocacy, and thus may address barriers to care often observed in racial and ethnic minority patient populations. Adding care managers to the care team to provide patient advocacy, symptom assessment, and feedback to clinicians may result in improvements in the delivery of care and patient outcomes.
EVALUATION PLAN
Funded by Finding Answers in 2010.
Researchers are conducting a randomized controlled trial of pregnant women. Outcome measures include the timely diagnosis and initiation of treatment for major depression, and the continuity of care for depression during the transition from pregnancy care to postpartum care.
The researchers are examining how many participants with risk of a current major depressive episode complete a diagnostic interview within two weeks of a positive screening; the number of women diagnosed with a major depressive episode who then initiate treatment for depression within one month; and the number of patients receiving treatment for depression who continue their treatment after giving birth. Additionally, the cost and potential economic benefits of implementing and maintaining the intervention are being assessed. Site-specific implementation is being analyzed using participant observation and semi-structured interviews at each of the four study sites.
Principal Investigators:
- Steven Ratcliffe, MD (Director of Family Medicine, Lancaster General Hospital)
- Ian M. Bennett, MD, PhD (Assistant Professor of Family Medicine and Community Health, University of Pennsylvania School of Medicine)
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