Megan O’Grady

Early experience of a pilot intervention for patients with depression and chronic medical illness in an urban ACO

OBJECTIVE The objective was to describe the design, implementation and preliminary results of a collaborative care pilot program using hybrid colocation and centralized care management for patients with depression and chronic medical illness in an urban accountable care organization. METHODS Patients with chronic illness (diabetes mellitus, coronary artery disease and/or congestive heart failure) and comorbid depressive symptoms (Patient Health Questionnaire [PHQ]9 score ≥10) were enrolled. The interventions included collaborative care for depression and chronic conditions; behavioral support, including short-term psychotherapy by licensed clinical social worker on-site or telephonically; off-site nurse care management and psychiatrist consultation through an electronic medical record. RESULTS Forty-four percent of patients (n=61) achieved a depression response. In a diabetes subgroup with depression and glycosylated hemoglobin level HbA1c >8 (n=21), 33% had a depression response with a minimum 0.5% HbA1c reduction. Among a subgroup (n=25) with Framingham risk score >15% and depression, mean PHQ9 depression scores and mean Framingham scores were reduced by 35% and 34%, respectively. CONCLUSIONS Early experience of the pilot for multiple chronic illnesses and depression appears feasible and shows initial promise.

Chapter 7: Indicators and monitoring

A popular paradigm states: What cannot be measured cannot be managed. The programmatic and practical objectives of the city and members of the New York City Climate Change Adaptation Task Force are to develop Flexible Adaptation Pathways for the region’s critical infrastructure. These objectives will require ongoing and consistent monitoring of a set of climate change indicators. Monitoring of key indicators can help to initiate course corrections in adaptation policies and/or changes in timing of their implementation. The relevant indicators are related to changes in the climate, climate science, climate impacts, and adaptation activities. Thus, these indicators need to be devised and tracked over time to provide targeted quantitative measures of climate change impacts, and adaptation in order to provide useful information to decision makers in regard to timing and extent of adaptation actions.

Development and Testing of an Addiction Treatment Level of Care Determination Tool

Two studies examined inter-rater reliability and content-related validity of an addiction treatment level of care determination tool currently in use in New York, the LOCADTR 3.0. The studies occurred after tool implementation. In study 1, 139 providers used the LOCADTR 3.0 to determine level of care for four case vignettes. Inter-rater reliability coefficients were calculated. In study 2, 387,338 state records from existing data were analyzed to determine how often providers opted to override the LOCADTR 3.0 level of care determination by choosing an alternative level of care. In study 1, an acceptable inter-rater reliability (IRR = .57–.59) was found. Good indication of content-related validity was also found; participants chose the same level of care the study team chose for each vignette 80% of the time. In study 2, the override option was selected only 10% of the time, further establishing the content validity of the tool. These studies provide evidence for acceptable preliminary reliability and validity of the LOCADTR 3.0.