The COMPASS initiative: description of a nationwide collaborative approach to the care of patients with depression and diabetes and/or cardiovascular disease.

OBJECTIVE: To describe a national effort to disseminate and implement an evidence-based collaborative care management model for patients with both depression and poorly controlled diabetes and/or cardiovascular disease across multiple, real-world diverse clinical practice sites. METHODS: Goals for the initiative were as follows: (1) to improve depression symptoms in 40% of patients, (2) to improve diabetes and hypertension control rates by 20%, (3) to increase provider satisfaction by 20%, (4) to improve patient satisfaction with their care by 20% and (5) to demonstrate cost savings. A Care Management Tracking System was used for collecting clinical care information to create performance measures for quality improvement while also assessing the overall accomplishment of these goals. RESULTS: The Care of Mental, Physical and Substance-use Syndromes (COMPASS) initiative spread an evidence-based collaborative care model among 18 medical groups and 172 clinics in eight states. We describe the initiative's evidence-base and methods for others to replicate our work. CONCLUSIONS: The COMPASS initiative demonstrated that a diverse set of health care systems and other organizations can work together to rapidly implement an evidence-based care model for complex, hard-to-reach patients. We present this model as an example of how the time gap between research and practice can be reduced on a large scale.

A technology solution for the high-tech diagnostic imaging conundrum.

OBJECTIVES: (1) To describe a unique initiative to implement a standardized system of electronic decision support for ambulatory orders for hightech diagnostic imaging (HTDI) statewide, and (2) to evaluate the impact of a pilot version of that system, plus prior notification on the volume of such orders. STUDY DESIGN: Description of the initiative and analysis of aggregated claims data. METHODS: Claims data for HTDI studies were aggregated from the main health plans in the state from 2003 to 2010 by the regional quality improvement collaborative that also facilitated the pilot and subsequent initiative being implemented in 2011 throughout Minnesota. RESULTS: Aggregate ambulatory statewide orders for HTDI tests increased from 32 to 41 per 1000 members from 2003 to 2006 (9% per year) at which point the rate leveled off through 2010. This trajectory change was simultaneous with implementation of an electronic medical record-based decision-support system for all ambulatory HTDI orders from 45% of the physicians in the state, as well as a prior notification/authorization approach by payers for the rest of the HTDI orders. CONCLUSIONS: Although it is not possible to disentangle the effects of these separate approaches, the much greater physician acceptance of the decision support system has led payers to financially support the creation of a unique statewide implementation of a version of this system to replace prior notification/authorization approaches.