Depression Care Initiative Yields Significant Decrease in Suicides
Megan Brooks
May 18, 2010 — A depression care quality improvement initiative has succeeded in significantly curbing the rate of suicide in some 200,000 members of a large health maintenance organization, according to an article published in the May 19 theme issue on mental health in the Journal of the American Medical Association.
The Perfect Depression Care program was created in 2001 by the Behavioral Health Services (BHS) Division of Henry Ford Health System, Detroit, Michigan, a large integrated mental health and substance abuse system that included 2 inpatient hospitals and 10 clinics serving southeastern Michigan and adjacent sites.
In the first 4 years of the program's implementation, the rate of suicide in Henry Ford's patient population decreased by 75% from 89 per 100,000 patients to 22 per 100,000, significantly lower than the annual rates for suicides in similar patient populations, according to the article. For the last 2½ years, that rate has been 0 per 100,000 compared with an expected rate of 230 per 100,000.
"We are pretty proud of accomplishing a goal that no one thought possible," C. Edward Coffey, MD, Henry Ford Health System vice president and CEO of BHS, told Medscape Psychiatry.
"My belief is that the most important thing we did was embrace the goal of no deaths from suicide for people under our care. That kind of audacious goal really forces you to do things differently because the usual incremental approaches aren't going to get you to that kind of a goal," Dr. Coffey said.
Key Components
Some of the key performance improvements of the program include the following:
- Establish a consumer advisory panel to help with the design of the program;
- Establish a protocol to assign patients to 1 of 3 levels of risk for suicide, each of which requires specific intervention;
- Provide training for all psychotherapists to develop competency in cognitive behavior therapy;
- Implement a protocol for having patients remove weapons from the home;
- Establish 3 means of access for patients: drop-in group medication appointments, advanced (same-day) access to care or support, and email visits;
- Develop a website for patients to educate and assist patients;
- Require staff to complete a suicide prevention course;
- Set up a system for staff members to check in on patients by telephone; and
- Partner and educate the patient's family members.
"If I had to vote on one key component," Dr. Coffey said, "it would be the perfection methodology that we established. I learned the hard way that that sort of goal setting is not for everyone. Culture is the key. It takes a certain type, one that can make peace with pursuing perfection and at the same time realizing you might not ever truly get there, but for those of us who like doing that, the excitement is in the journey as much as it is in getting to the destination."
Nationally Recognized Program
In a telephone interview, Vinod (Vin) Sahney, PhD, founding member (retired) of the Institute for Healthcare Improvement (IHI), said Dr. Coffey has "really focused on managing these people at risk for suicide; he developed monitoring and alert systems and is achieving quite good results."
"I have worked with IHI on health care improvement, and we have worked on a number of things, such as reducing patient falls in hospitals and reducing infection rates, and in every single area, we have found that if you systematically look at the causes and train people in areas of improvement, you can have a tremendous impact," Dr. Sahney added.
Henry Ford's Perfect Depression Care program has been nationally recognized and awarded the Joint Commission's Ernest Amory Codman Award, a health care award that recognizes excellence in performance measurement. The program has also received the Gold Achievement Award from the American Psychiatric Association.
Dr. Coffey and Dr. Sahney have disclosed no relevant financial relationships.
JAMA. 2010;303:1903-1904.
Megan Brooks
Megan Brooks is a freelance writer for Medscape.
-From http://www.medscape.com/viewarticle/721983 retrieved 5/24/10
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