1. Treating Depression in Primary Care Keri Lijewski, M.D. Quality Director River Falls, Ellsworth, and Spring Valley Medical Clinics of Western Wisconsin

2. About our clinics Independent, physician owned practice Primary care based 15 primary care physicians, 4 surgical specialists, and 5 midlevel providers Three sites – large clinic in River Falls, satellite clinics in Ellsworth and Spring Valley History of strong performance in quality measures

3. Long recognized difficulties with treatment of depression Patients can be hesitant to mention Often mentioned at the end of a visit Varying comfort levels with treatment of depression Lack of communication with psychological services in the area Lack of availability of psychiatrists for referrals

4. Our experience with DIAMOND Became involved with the project in 2008 Had three physicians, four administrators, and three care coordinators go through training Launched in March 2009 Withdrew from the project in March 2010

5. What DIAMOND taught us about managing depression Screening for depression is critical Follow up of depression is critical Excellent treatment of depression requires more than a single clinic visit

6. Our barriers to DIAMOND success We had poor payor coverage for DIAMOND We never had a large enough number of patients participating for our system to get in a good rhythm The care coordinators were not focused on depression We were working with a consultant from MHN/MNCM who had different ideas about the role of care coordinators The reporting aspect was overly burdensome for our management staff

7. Current practice of depression treatment at our clinics PHQ-9 form for diagnosis and monitoring Care coordinators available for follow up with patients EMR system in place allowing for a robust recall process that can include follow up visits

8. Ongoing challenges Getting patients to come back in for follow up visits Consistency in how providers manage depression Consistently using the recall system to track patients due for visits Turnover in care coordinator staff EMR reporting not yet a useful registry