The Depression – Population Approach to Health (Depression – PATH) project started in November, 2016 as part of a system-wide care transformation initiative to improve depression care and outcomes for patients within the UW Medicine primary care network. Led by Denise Chang, MD, Marc Avery, MD, and Jürgen Unützer, MD, MPH, the program initially focused on patients who were part of the UW Medicine Accountable Care Network (ACN), with goals of improving oversight of depression treatment, tracking treatment outcomes and increasing the use of evidence-based practices within the primary care network.

Through individual chart reviews, the PATH team identified opportunities for improving depression care and relayed recommendations back to the primary care team. However, in the majority of cases, patients didn’t return for follow-up depression care and/or did not receive a subsequent PHQ-9 questionnaire (depression screener). Therefore, ensuring patients with a depression diagnosis receive appropriate follow-up care and depression screening became the principal area for improvement. The PATH team centralized monitoring of these patients and achieved some success. In the last quarter of 2017, the team saw improvements in PHQ-9 outcomes in one target group, with nearly 30% of patients achieving either remission or response. Through this process, the team identified several challenges with the initial approach and design of the project, including scalability and the lack of alignment among similar population health initiatives. Individual chart reviews for patients is not likely sustainable if the project expanded to include additional patient populations and ultimately is not an effective use of time, especially when the majority of patients simply need follow-up.

The Depression PATH team is working to improve workflow processes in order to be more efficient in identifying, tracking and improving outcomes for depressed patients, and at the same time is looking to broaden its scope of patients. This new approach will leverage existing BHIP (Behavioral Health Integration Program) teams in the management of the primary care provider’s panel of depressed patients, ensuring patients are receiving follow-up care and PHQ-9s when needed. Meanwhile, the PATH team will continue to provide centralized monitoring and surveillance, coordinate with the BHIP teams and align with similar population health initiatives focused on depression, such as the Depression Ambulatory Clinical Pathway. The PATH team is currently testing the new project plan at two UW Neighborhood Clinic sites and plans to scale implementation to all UW Neighborhood Clinics by 2019.