Improving Care for Late-Life Depression Through Partnerships With Community-Based Organizations: Results From the Care Partners Project.

OBJECTIVES: Collaborative care (CC) has demonstrated effectiveness for improving late-life depression in primary care, but clinics offering this service can find it challenging to address unmet social needs that may be contributing to their patients' depression. Clinics may benefit from better coordination and communication with community-based organizations (CBO) to strengthen depression treatment and to address unmet social needs. We evaluated the feasibility of adding a CBO to enhance standard collaborative care and the impact of such partnered care on older adults. DESIGN: Multisite, prepost evaluation. SETTING: Eight (n = 8) partnerships between primary care clinics and community-based organizations in California. PARTICIPANTS: A total of 707 depressed older adults (60 years or older) as evidenced by having a score of 10 or more on the Patient Health Questionnaire (PHQ-9) received care under the Care Partners project. INTERVENTION: A CBO partner was added to augment CC for late-life depression in primary care. MEASUREMENTS: The PHQ-9 was used to identify depressed older adults and to monitor depression symptom severity during a course of care. RESULTS: At baseline, the average PHQ-9 depression score across the partnerships was 15, indicating moderate depression severity. Participating patients saw an average 7-point reduction in their PHQ-9 score, baseline to last score assessed, with nearly half of all participants (48.4%) experiencing a 50% or greater improvement from their baseline score. CONCLUSIONS: Our findings suggest that partnering with a community-based organization is a feasible and effective way for primary care clinics to address late-life depression in their patients.

The Hartford Geriatric Nursing Initiative: developing a focused strategy and strong partnerships to improve nursing care for older adults.

This article traces the funding priorities of the John A. Hartford Foundation--the largest private philanthropy in the United States dedicated to aging and health--to increase the competence of the health care workforce (physicians, nurses, and social workers) to care for our aging society. A review of the Foundation's 15-year and over $70 million investment in geriatric nursing is presented with emphasis on 2 critical factors--a focused strategy and strong partnerships--to build the nation's nursing capacity to meet the health care needs of older Americans. The evolution of Hartford's strategic goal to ensure that all nurses are skilled to care for older adults is shared to illustrate why the Foundation now funds nursing efforts in the primary areas of faculty development and curricular change. This article also underscores the importance of establishing a network of diverse partnerships and collaborations to maximize impact and create synergies.

Symptoms, affects, and self-rated health: evidence for a subjective trajectory of health.

OBJECTIVE: Self-rated health (SRH) is known to predict mortality and other health outcomes better than objective ratings, suggesting that patients have important knowledge that physicians do not. The study assessed whether SRH reflects changes in internal states, specifically symptoms and affects. METHOD: In an event-sampling study, 54 elders completed a SRH measure, positive and negative affect scale, a symptom checklist, and a pain scale every evening for 8 weeks. Using lagged (time series) hierarchical regression, the authors modeled associations of SRH with previous symptoms, moods, and changes in symptoms and mood. RESULTS: The SRH was highest when symptoms had decreased from the previous day and lowest when symptoms had increased, suggesting that SRH reflects a sense of change. Symptoms and affects contributed independently to SRH. Self-rated health was more sensitive to positive than negative affect and also sensitive to changes of positive but not negative affect. DISCUSSION: Patients may possess a subjective trajectory of health-an awareness of changes in symptoms and affect. This trajectory may constitute an important component of SRH and help to explain its ability to predict health outcomes.

Physicians' satisfaction with a collaborative disease management program for late-life depression in primary care.

OBJECTIVE: This study describes physicians' satisfaction with care for patients with depression before and after the implementation of a primary care-based collaborative care program. METHOD: Project Improving Mood, Promoting Access to Collaborative Treatment for late-life depression (IMPACT) is a multisite, randomized controlled trial comparing a primary care-based collaborative disease management program for late-life depression with care as usual. A total of 450 primary care physicians at 18 participating clinics participated in a satisfaction survey before and 12 months after IMPACT initiation. The preintervention survey focused on physicians' satisfaction with current mental health resources and ability to provide depression care. The postintervention survey repeated these and added questions about physician's experience with the IMPACT collaborative care model. RESULTS: Before intervention, about half (54%) of the participating physicians were satisfied with resources to treat patients with depression. After intervention, more than 90% reported the intervention as helpful in treating patients with depression and 82% felt that the intervention improved patients' clinical outcomes. Participating physicians identified proactive patient follow-up and patient education as the most helpful components of the IMPACT model. CONCLUSIONS: Physicians perceived a substantial need for improving depression treatment in primary care. They were very satisfied with the IMPACT collaborative care model for treating depressed older adults and felt that similar care management models would also be helpful for treating other chronic medical illnesses.

Decades of focus: grant making at the John A. Hartford Foundation.

Foundation grant making can play an important role in advancing the U.S. health agenda. However, given the scale of the health care system and the intractability of many of its problems, philanthropy must be guided by strategic thinking in pursuit of realistically achievable goals. This essay describes the grant-making process at one nationally oriented foundation as an example of how these challenges might be approached. We believe that greater clarity about this process can improve collaboration among foundations, help the public appreciate foundations' work, facilitate partnerships with grantees, and, most importantly, yield sustainable improvement in the problem being addressed.