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Remission rate for Boeing employees climbed from 10% to 35%
SAN FRANCISCO – Under an accountable care contract with airplane maker Boeing, the University of Washington, Seattle, increased the rate of depression remission from about 10% to 35%, and the number of people in remission improved, based on Patient Health Questionnaire (PHQ-9) scores, from 20% to 70% – both in less than a year.
Boeing was particularly concerned about depression among its roughly 27,000 Puget Sound–area employees when it entered a contract with the University of Washington (UW) a few years ago for health services. Workers with depression are less likely to show up to work, and when they do, they are more likely to make mistakes and cause safety problems. To ensure that the university addressed the problem, Boeing tied payments to improved depression scores.
It didn’t take UW long to meet the PHQ-9 targets for improvement and remission, meaning a score below 5 points. Boeing also wanted its employees to be screened annually for depression and repeated testing of patients with depression to track how well they were doing. The university increased the number of patients rescreened within 8 weeks of their first PHQ-9 from about 45% to 75% – also in less than a year.
It simply scaled up the approach to meet Boeing’s targets.
“This has been an interesting journey,” said Jürgen Unützer, MD, MPH, who has been key to the efforts. “It’s required quite a bit of work, but it can be done. We’ve made a lot of progress,” he said at the American Psychiatric Association annual meeting.
Key components, besides the primary care provider, include evidence-based treatment, a mental health case manager, a system to track outcomes, and a psychiatrist to consult when patients do not improve. It’s a team approach.
Dr. Unützer and his colleagues have proved that it can work among older adults with depression and, in the end, save money (Am J Manag Care. 2008 Feb;14[2]:95-100). They’ve even published a how-to book, “Integrated Care: Creating Effective Mental and Primary Health Care Teams” (John Wiley & Sons, 2016).
A key challenge with Boeing was making sure that depressed patients returned for follow-up care and repeat PHQ-9s, and that they did not languish on ineffective treatments.
“We explain [to them that] this is not just a one-time thing,” said Dr. Unützer, chair of psychiatry and behavioral sciences at UW. “We [will] keep with them until they are well.”
Patients are enrolled in the patient portal on UW’s Epic records system to facilitate communication. The system sends out follow-up reminders, and sometimes it is used to send PHQ-9s directly to patients.
“We have automated this as much as possible.” When there’s no response, patients often are sent text messages or called by phone to make sure that they are doing OK and taking their medicine, he said.
Chart reviews are used to identify patients who are not improving. “We reach out to primary care and say, ‘We think you could use some help.’ It’s not always ”a comfortable conversation. “A lot of us like to assume our patients are getting better,” Dr. Unützer said.
Overall, “this notion of population-based care – the idea that ... you have a whole bucket of patients out there you might have seen at some point” but are still responsible for – “is a total change for most of us who are practicing clinicians,” he said.
Dr. Unützer did not report any disclosures.
Remission rate for Boeing employees climbed from 10% to 35%
Remission rate for Boeing employees climbed from 10% to 35%
SAN FRANCISCO – Under an accountable care contract with airplane maker Boeing, the University of Washington, Seattle, increased the rate of depression remission from about 10% to 35%, and the number of people in remission improved, based on Patient Health Questionnaire (PHQ-9) scores, from 20% to 70% – both in less than a year.
Boeing was particularly concerned about depression among its roughly 27,000 Puget Sound–area employees when it entered a contract with the University of Washington (UW) a few years ago for health services. Workers with depression are less likely to show up to work, and when they do, they are more likely to make mistakes and cause safety problems. To ensure that the university addressed the problem, Boeing tied payments to improved depression scores.
It didn’t take UW long to meet the PHQ-9 targets for improvement and remission, meaning a score below 5 points. Boeing also wanted its employees to be screened annually for depression and repeated testing of patients with depression to track how well they were doing. The university increased the number of patients rescreened within 8 weeks of their first PHQ-9 from about 45% to 75% – also in less than a year.
It simply scaled up the approach to meet Boeing’s targets.
“This has been an interesting journey,” said Jürgen Unützer, MD, MPH, who has been key to the efforts. “It’s required quite a bit of work, but it can be done. We’ve made a lot of progress,” he said at the American Psychiatric Association annual meeting.
Key components, besides the primary care provider, include evidence-based treatment, a mental health case manager, a system to track outcomes, and a psychiatrist to consult when patients do not improve. It’s a team approach.
Dr. Unützer and his colleagues have proved that it can work among older adults with depression and, in the end, save money (Am J Manag Care. 2008 Feb;14[2]:95-100). They’ve even published a how-to book, “Integrated Care: Creating Effective Mental and Primary Health Care Teams” (John Wiley & Sons, 2016).
A key challenge with Boeing was making sure that depressed patients returned for follow-up care and repeat PHQ-9s, and that they did not languish on ineffective treatments.
“We explain [to them that] this is not just a one-time thing,” said Dr. Unützer, chair of psychiatry and behavioral sciences at UW. “We [will] keep with them until they are well.”
Patients are enrolled in the patient portal on UW’s Epic records system to facilitate communication. The system sends out follow-up reminders, and sometimes it is used to send PHQ-9s directly to patients.
“We have automated this as much as possible.” When there’s no response, patients often are sent text messages or called by phone to make sure that they are doing OK and taking their medicine, he said.
Chart reviews are used to identify patients who are not improving. “We reach out to primary care and say, ‘We think you could use some help.’ It’s not always ”a comfortable conversation. “A lot of us like to assume our patients are getting better,” Dr. Unützer said.
Overall, “this notion of population-based care – the idea that ... you have a whole bucket of patients out there you might have seen at some point” but are still responsible for – “is a total change for most of us who are practicing clinicians,” he said.
Dr. Unützer did not report any disclosures.
SAN FRANCISCO – Under an accountable care contract with airplane maker Boeing, the University of Washington, Seattle, increased the rate of depression remission from about 10% to 35%, and the number of people in remission improved, based on Patient Health Questionnaire (PHQ-9) scores, from 20% to 70% – both in less than a year.
Boeing was particularly concerned about depression among its roughly 27,000 Puget Sound–area employees when it entered a contract with the University of Washington (UW) a few years ago for health services. Workers with depression are less likely to show up to work, and when they do, they are more likely to make mistakes and cause safety problems. To ensure that the university addressed the problem, Boeing tied payments to improved depression scores.
It didn’t take UW long to meet the PHQ-9 targets for improvement and remission, meaning a score below 5 points. Boeing also wanted its employees to be screened annually for depression and repeated testing of patients with depression to track how well they were doing. The university increased the number of patients rescreened within 8 weeks of their first PHQ-9 from about 45% to 75% – also in less than a year.
It simply scaled up the approach to meet Boeing’s targets.
“This has been an interesting journey,” said Jürgen Unützer, MD, MPH, who has been key to the efforts. “It’s required quite a bit of work, but it can be done. We’ve made a lot of progress,” he said at the American Psychiatric Association annual meeting.
Key components, besides the primary care provider, include evidence-based treatment, a mental health case manager, a system to track outcomes, and a psychiatrist to consult when patients do not improve. It’s a team approach.
Dr. Unützer and his colleagues have proved that it can work among older adults with depression and, in the end, save money (Am J Manag Care. 2008 Feb;14[2]:95-100). They’ve even published a how-to book, “Integrated Care: Creating Effective Mental and Primary Health Care Teams” (John Wiley & Sons, 2016).
A key challenge with Boeing was making sure that depressed patients returned for follow-up care and repeat PHQ-9s, and that they did not languish on ineffective treatments.
“We explain [to them that] this is not just a one-time thing,” said Dr. Unützer, chair of psychiatry and behavioral sciences at UW. “We [will] keep with them until they are well.”
Patients are enrolled in the patient portal on UW’s Epic records system to facilitate communication. The system sends out follow-up reminders, and sometimes it is used to send PHQ-9s directly to patients.
“We have automated this as much as possible.” When there’s no response, patients often are sent text messages or called by phone to make sure that they are doing OK and taking their medicine, he said.
Chart reviews are used to identify patients who are not improving. “We reach out to primary care and say, ‘We think you could use some help.’ It’s not always ”a comfortable conversation. “A lot of us like to assume our patients are getting better,” Dr. Unützer said.
Overall, “this notion of population-based care – the idea that ... you have a whole bucket of patients out there you might have seen at some point” but are still responsible for – “is a total change for most of us who are practicing clinicians,” he said.
Dr. Unützer did not report any disclosures.
REPORTING FROM APA 2019