Santa Barbara County

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Santa Barbara County Public Health Department

• Santa Barbara County, California
• Pacific West Cluster
• Depression Collaborative

Learning Session 2 Atlanta, Georgia May 12 14,
2005
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Santa Barbara County Public Health Department

• 7 Clinics Carpinteria, Franklin, Santa Barbara,
  Lompoc, Santa Maria, Santa Maria Womens Health
  Center, and New Cuyama
• Over 110,000 patient visits each year, primarily
  low-income, uninsured and underinsured
• Services include primary care services,
  infectious disease services, medical social
  services, OB/GYN care, tuberculosis chest
  clinic, surgical, and numerous other specialty
  and sub-specialty clinics
• 1,904 patients were seen in the past year with
  some type of depression diagnosis

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Team Members

• Executive Director Elliot Schulman, MD, MPH
• Medical Director/
• Provider Champion Earl Lynch, MD, MPH
• HDC Clinic Provider John Landsberg, MD
• Clinic Manager Elizabeth Snyder, MHA
• Clinic Support Dwayla Patterson, RN
• Senior Leader Michael Harris
• Team Leader Dana Gamble, LCSW
• MQI Superstar Brooke Chilcott, PHN
• IT Guru Aurelia Fajardo
• Key Contact Dana Gamble
• dgamble_at_sbcphd.org

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Population of Focus

• Our population of focus includes patients of
  John Landsberg, MD, of the Santa Barbara Public
  Health Clinic, who have a diagnosis of major
  depression, dysthymia, minor depression,
  depression NOS and adjustment disorder with
  depressed features. The Population of Focus is
  currently 133 patients.

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AIM Statement
The Santa Barbara County Public Health Department
will redesign the chronic care delivery system
for our patients with depression. We will achieve
our goals by Creating a team approach to care,
where the patient, provider and clinic
administration work together toward healing and
symptom management Applying new clinical
information systems Helping clients develop
self-management goals Making changes in our
delivery system design and, Targeting each
clinical visit as an opportunity to improve our
patients physical and behavioral health. Our aim
will be accomplished through the Care Model and
progress will be measured through the monitoring
of our key measures.
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Selected Measures
CSD patients with 50 reduction in PHQ gt40 CSD
patients with a 5 point reduction in PHQ score
within 6 months gt50 CSD patients with documented
PHQ reassessment between 4-8 weeks of last New
Episode PHQ gt70 Patients who have a diagnosis
of depression and a documented PHQ score within
the last 6 months gt70 Depressed patients with
documented self-management goal setting in the
last 12 months gt70 Additional Measure Patients
with a diagnosis of depression or dysthymia will
remain on an antidepressant for at least 6
monthsgt70
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Self-management

• Currently Testing
• The effectiveness of the Self-Management Tool
  with patients
• Spanish Version of the Self-Management Tool
• Implemented into our Delivery System
• Self-management as a component of depression care
• A regularly scheduled Depression Clinic

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Community

• Currently Testing
• Existing partnerships and resources in the
  community
• Implemented into our Delivery System
• Enhanced key partnerships with the Department of
  Alcohol, Drug and Mental Health Services

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Healthcare Organization

• Currently Testing
• HDC implementation plan and improvement
  strategies
• Implemented into our Delivery System
• PDSAs have been incorporated into weekly team
  meeting agenda
• Executives of the Public Health Department have
  been educated about the Care Model and support
  the Collaborative effort

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Decision Support

• Currently testing
• The user-friendliness of the depression encounter
  sheet
• Identification of specialist resources

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Clinical Information System

• Currently Testing
• Formalization of the data collection process and
  the data team
• Implemented into Delivery System
• Data abstraction tool and PECS data entry
  methodology

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Delivery System Design

• Currently Testing
• Appointment systems supporting the needs of our
  patients including follow-up activities and
  self-management goal setting
• Implemented into Delivery System
• Primary Care Patient Care Teams made up of
  provider, nurse medical assistant, and
  care-management educator. Using team huddle
  after the depression clinic to PDSA the delivery
  system

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Functional and Clinical Outcomes
Measures Goal as of 5/2005 CSD Patients with
50 reduction in PHQ gt40 0 CSD patients with
a 5 point reduction in PHQ score within 6
months gt50 0 CSD patients with documented
PHQ reassessment between 4-8 weeks of last New
Episode PHQ gt70 0 Patients who have a
diagnosis of depression and a documented PHQ
score within the last 6 months
gt70 4.3 Depressed patients with documented
self-management goal setting in the last 12
months gt70 4.3 Patients with a diagnosis
of depression or dysthymia will remain on an
antidepressant for at least 6 months
gt70 0
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National Key Measures
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National Key Measures (cont.)
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National Key Measures (cont.)
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Senior LeadershipMaking the Case for Change

• Michael Harris, our Senior Leader, presented to
  the Santa Barbara County Board of Supervisors on
  May 10, 2005. Highlighted in his presentation,
  broadcast County-wide on local television, was
  the Health Disparities Collaborative (HDC).  The
  HDC was explained as one of the approaches to
  respond to the ever-increasing enrollment into
  the County's seven clinic network.  As it was
  explained to the Board by Mr. Harris, "The County
  must adapt to a new system of care.  A system
  predicated on chronic disease management.
  Management by the medical staff and health
  educators but most importantly, self-management
  by the patient.  Designing a system of care that
  empowers patients is our greatest chance of
  success in managing our local health care
  crisis".

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Communication Plan

• At the center level
• Monthly updates at the Primary Care Division
  Meeting
• Distribution of the Senior Leader Report
• At the Community level
• We will communicate our progress at the community
  level following several more PDSA cycles on the
  delivery system

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Anticipating Barriers and Issues
Those that the team can resolve
Those that leadership needs to address

• Clinical decision making
• Staff responsibilities
• Education for additional staff
• Patient flow issues between Provider and Care
  Manager, I.e bottle-necking due to shorter
  provider visit and longer care management visit

• Adding additional care management components,
  I.e., self-management support groups, improved
  collaboration with community behavioral health
  providers
• Resources for time and equipment

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A story to share.the patient
We are still at the early stages of implementing
the Care Model, but from the very first patient
visit to the most recent, the patients have been
tremendously pleased with the personalized
attention offered to them. In fact, one patient
commented on how special the service made her
feel, and we felt this was validation of
increased sense of self-worth and importance
associated with the HDC model.
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A story to share.our staff

• The care model is based on a team approach. We
  have created team spirit amongst staff in an area
  where there previously was none. There is now a
  true interest to work together to create an
  effective program that helps patients take
  control of their chronic care, and the clinic
  system to deliver effective, and excellent,
  services.

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A story to shareThe organization

• At this point the organization, as a whole, is in
  a wait and see mode. Sort of like Star Wars
  fans waiting for the next installment. There has
  been a certain buzz created by the internal
  publicity, outreach and hype. However, the
  pressure is on Will the collaborative do all
  that has been promised? Our answer is, You bet!
  The Force is with Us!