More prominent New Orleans Community to Enhance Behavioral Human services Access (C-IBHA) with backing from the Robert W.


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More prominent New Orleans Cooperative to Enhance Behavioral Social insurance Access (C-IBHA) with backing from the Robert Wood Johnson Establishment Harold Alan Pincus, MD Bad habit Executive, Division of Psychiatry Columbia College Chief of Value and Results Look into New York-Presbyterian Healing center
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More noteworthy New Orleans Collaborative to Improve Behavioral Healthcare Access (C-IBHA) with backing from the Robert Wood Johnson Foundation Harold Alan Pincus, MD Vice Chairman, Department of Psychiatry Columbia University Director of Quality and Outcomes Research New York-Presbyterian Hospital Senior Scientist RAND Corporation RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Overall Plan (1) Introduction-Harold Pincus Clinical/Provider-Steven Cole Practice-Amy Kilbourne Improvement Process-Karen Scott Collins Patient Self-Management-Jeanie Knox-Houtsinger RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Overall Plan (2) Plenaries Breakouts In-Between After RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Why Behavioral Health and General Health Care? Discouragement Preventive/endless disease watch over individuals with Severe Mental Illness Disaster reaction RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Why Depression? Pervasive Significant individual, social and monetary effect Strong clinical science base Strong proof on consideration change mediations Depression as a constant ailment Large crevice in the middle of confirmation and activity RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Ischaemic coronary illness Unipolar real sorrow Road movement wounds Cerebrovascular ailment Chronic obstructive aspiratory sickness Lower respiratory contaminations Tuberculosis War Diarrhoeal ailments HIV 2020 World Health Organization Burden of Disease (DALYs) DALY = Disability-balanced life year Source: WHO, Evidence, Information and Policy, 2000 RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Leading Causes of Years of Life Lived with Disability (YLD) in 15-to 44-Year-Olds (WHO, Mental Health: New Understanding, New Hope, 2001) RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Why Depression? Common Significant individual, social and monetary effect Strong clinical science base Strong confirmation on consideration change mediations Depression as a constant ailment Large hole in the middle of proof and activity RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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The State of Health Care Quality 2006 , NCQA There are, be that as it may, aggravating exemptions to this example of [overall medicinal services quality] change. The nature of administer to Americans with emotional well-being issues stays as poor today as it was quite a long while prior. Patients on upper solution speak the truth as liable to get proper care today as they were in 1999. www.ncqa.org RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Antidepressant Medication Management: The Case for Improvement RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Antidepressant Medication Management: The Case for Improvement (cont’d.) RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Antidepressant Medication Management: The Case for Improvement (cont’d.) RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Prevalence of Major Depression in Patients with Physical Illnesses General populace Up to 10% Myocardial dead tissue Up to 22% Diabetes Up to 27% Hypertension Up to 29% Epilepsy Up to 30% Stroke Up to 31% Cancer Up to 33% HIV/AIDS Up to 44% Up to 46% Tuberculosis RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans) WHO, 2003.

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Comorbidities Among Depressed Patients Source: http://www.medstat.com/social insurance/depression4.asp RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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General Medical Comorbidity in extreme emotional instability Diabetes: 20% Cardiovascular sickness: HBP 34%, Heart 15.6% Weight addition and stoutness (2x) Smoking (2x) Other: bosom growth (9.5x), HIV (8x), Hepatitis B (5x) and C (10x) Reduced life compass RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Mental-Health Challenge Emerges As Victims Face Multiple Traumas BATON ROUGE, La. – “…Post-traumatic anxiety issue, sorrow and uneasiness are normal after significant catastrophes, psychological well-being specialists say, on the grounds that fiascos terrify individuals and upset their lives. Be that as it may, Hurricane Katrina postures unique challenges…” “…The hurricane’s change additionally has exacerbated the side effects of a few individuals who experience the ill effects of formative handicaps and dysfunctional behaviors, for example, schizophrenia…” RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Why Not? (Boundaries) Historical Conceptual Patients/Consumers Providers Practices/Delivery Systems Plans – Managed Care Organizations (MCO)/Managed Behavioral Health Organizations (MBHO) Purchasers – Public/Private Population/Community RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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What’s Unique about Behavioral Health? Brain body dualism Stigma Role of the state Legal/administrative qualifications (e.g., protection, competency) Multiple perplexing frameworks characteristically included (e.g., social administrations, criminal equity, training, customer coordinated, and so forth.) Different indicative frameworks RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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What’s Unique about Behavioral Health? (proceeded with) Separate conveyance frameworks More heterogeneous work power/more prominent solo practice Few strategies Separate financing frameworks/diverse business sector structure Less created quality change/execution measures Less linkage to IT developments RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Conceptual Issues: Primary Care versus Emotional well-being Specialties Different points of view Definitions/clinical measures (i.e., no lab tests) Majority of writing originates from claim to fame (and regularly tertiary) care settings Diagnostic frameworks, for example, DSM-IV frequently seen as excessively complex and strength concentrated But DSM PC unsuccessful? Linkages between and among different frameworks (SUD, social administrations, schools, purchaser, coordinated, and so on.) RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Provider Barriers Time Interest Tools: DSM-PC, PHQ-9 Training RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Practices/Delivery System Issues Organization does not upgrade tolerant supplier cooperations & advance effective results Who is in charge of consideration? Constrained correspondence and collaboration between essential consideration and emotional wellness claims to fame How ought to care be given? Consultative? Community oriented? Incorporated? At the point when ought to care be given? Absence of longitudinal center RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Policy (Public and Private) Depression not on radar Stigma, inclination, deception Fragmentation empowered Quality not an element Change is coming quick RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Who? Obligation regarding Care PCP BHS RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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How? Incorporated Team Collaborative Care Consultative Care Referral Independent Autonomous (PCP) Autonomous (MHS) RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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When? RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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How? Techniques Chronic (Planned) Care Model The Robert Wood Johnson Foundation’s national project on Depression in Primary Care: Linking Clinical Systems and Strategies Models of linkage/joining Institute of Medicine/Crossing the Quality Chasm RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Evidence-Based Chronic (Planned) Care Approaches for Treating Depression Are Effective Community Health System Resources and Policies Health Care Organization Clinical Information Systems Self-Management Support Delivery System Design Decision Support Productive Interactions Patient-Centered Coordinated Timely and Evidence-Efficient Based and Safe Informed, Empowered Patient and Family Prepared, Proactive Practice Team Improved Outcomes RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Chronic Disease Clinical Models Hypertension Congestive heart disappointment (CHF)/Coronary conduit malady (CAD) Stroke COPD (Chronic Obstructive Pulmonary Disease) DM (Disease Management) Asthma Multiple comorbidities Transitional consideration administration RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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Depression Clinical Models Chronic (arranged) consideration model – Wagner Collaborative consideration – Katon Partners in Care (AHRQ) – Wells PROSPECT – Alexopoulous, Katz, Reynolds Telephone care administration – Simon, Hunkeler IMPACT (Hartford) – Unutzer RESPECT (MacArthur) – Dietrich Quality Improvement for Depression (NIMH) – Rost, Ford, Rubenstein Child models – Campo, Asarnow, GLAD-PC Other models for uneasiness/PTSD RWJF LPHI Kick-Off Meeting-July 29-30.2008 (New Orleans)

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A national project bolstered by The Robert Wood Johnson Foundation www.depressioninprimarycare.org National Program Office Harold Pincus, MD, Director Jeanie Knox Houtsinger, BA, Deputy Director Gail Wrobleski, Administrative Specialist Susanne Salem-Schatz, ScD, Quality Improvement Consultant John Bachman, PhD, Communications Consultant Donna Keyser, PhD, Communications Consultant The Robert Wood Johnson F

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