To increase value, a process for quality improvement
of depression is required that includes several key
ingredients. First, a model of care that is clearly
superior to practice as usual must have been demonstrated
to work in real world settings. Second, all
parties involved in the healthcare transaction need
to come together to develop shared definitions regarding
outcomes in the treatment of an illness or
disease. Third, attention to how practices might change
must be supported by modifications in the incentives
(reimbursements) involved to sustain positive improvements.
In this example, clinical outcomes (PHQ-9 response
and remission) that were meaningful to all
stakeholders were introduced along with improvements
in safety for depressed patients (consistent involvement
of a psychiatrist with the practice improves
access to evidence-based care) and service (care for
the patient where they present in primary care with
phone-based follow-up that does not require a visit).
The cost of introducing and sustaining this model in
practice was also part of the negotiation. In this case,
the cost was tied to outcomes (remission of depression)
rather than to procedures or visits. New
processes are needed in health care to create value in
depression management. The DIAMOND programme
offers a new direction for achieving this goal.