Depression Screening and Care Management in Diabetes Patients at Rural Health Clinics in Primary Care: Quality Improvement

Depression is one of the leading causes of disease and disability, often found in patients with long-term chronic physical conditions such as diabetes. Collaborative care, which includes care managers, has shown to improve depression outcomes in patients; usual care has been shown to be inadequate. This quality improvement project screened patients with diabetes for depression. Patients with an elevated depression screening score were provided care management support and rescreened every two weeks to evaluate depression symptoms. A small cohort of patients from two rural health clinics participated in the improvement project. The practices noted improvement in depression screening; patients who participated and received care management services had an overall improvement in Patient Health Questionnaire-9 (PHQ-9) scores and glycated hemoglobin (A1c) rates over the project period. The practice findings indicated that focusing on improved systems for rural health clinic patients with diabetes and depression may impact health outcomes, however, additional work needs to be done to determine sustainability in rural health clinics beyond the quality improvement project period. The quality improvement project limitations included study design and size

Substance Use Disorder Treatment Confidentiality Boot Camp

[Excerpt]: INTRODUCTION: The Health Law and Policy Programs at UNH School of Law, Institute for Health Policy and Practice, and the NH Citizens Health Initiative have contracted with several of the New Hampshire Building Capacity for Transformation Delivery System Reform Incentive Payment (DSRIP) Integrated Delivery Networks (IDN) to provide technical assistance to the IDNs as they develop confidentiality tools related to substance use disorder services projects. A UNH Team assisted the IDNs by providing an educational summary of federal and state confidentiality requirements, focusing on 42 CFR Part 2, and hosting IDN interdisciplinary teams in three Substance Use Disorder (SUD) Treatment Confidentiality Boot Camp sessions providing technical assistance to assist each IDN partner with their SUD confidentiality project goals. The “boot camp” consisted of several guided meetings with assigned homework to follow, leading to the ultimate development of processes, plans, and draft forms and policies to implement Part 2 confidentiality. The process incorporated learning from the Citizens Health Initiative’s existing New Hampshire Behavioral Health Integration Learning Collaborative. The Project was implemented during half-day working sessions between May 15 – July 30, based upon the availability of IDN interdisciplinary teams and as arranged in collaboration with the IDNs. The IDNs committed to including project leaders with knowledge about and authority to investigate issues regarding projects, patient flow, and privacy. The project teams were multi-disciplinary. IDN participants were encouraged to review issues, forms, and ideas with their individual legal counsel at any point. The technical assistance provided as part of this project is not and does not take the place of legal advice

Lessons learned from a multiagency community mental health centre quality improvement learning collaborative in New Hampshire

Background/Aims Community mental health centres in the US often struggle to implement the evidenced-based metrics and measurement processes required for quality reporting initiatives. Through the co-design and facilitation of a learning collaborative, all 10 community mental health centres in New Hampshire agreed on the goal of demonstrating measurement alignment and improvement across three behavioural health metrics related to depression and suicide risk, aiming for a screening rate of at least 85% in a year. Methods The learning system framework and Lean Six Sigma define, measure, analyse, improve and control methodologies were used to increase participation and improve quality reporting. Teams were asked to participate in both a group learning collaborative and individual centre facilitation sessions, working with a quality improvement specialist. Reported measures were compared with subsets of the population data and between centres. Outliers were identified for potential reporting inaccuracies and opportunities for improvement. Results All 10 community mental health centres were able to accurately report screening results on all three measures. After 12 months, 70% of the teams were able to reach the group-determined goal of at least 85% of eligible patients being screened in one measure, 40% of the teams met the benchmark in two measures and 20% of the teams were able to meet the benchmark in all three measures. Conclusions Early investment by community mental health centre leadership through the development of a shared aim and project outcomes is essential to support learning and achieve positive outcomes. Quality improvement specialists are vital for facilitation of shared learning and practice across organisations

Ca II H and K Chromospheric Emission Lines in Late K and M Dwarfs

We have measured the profiles of the Ca II H and K chromospheric emission lines in 147 main sequence stars of spectral type M5-K7 (0.30-0.55 solar masses) using multiple high resolution spectra obtained during six years with the HIRES spectrometer on the Keck 1 telescope. Remarkably, the average FWHM, equivalent widths, and line luminosities of Ca II H and K increase by a factor of 3 with increasing stellar mass over this small range of stellar masses. We fit the H and K lines with a double Gaussian model to represent both the chromospheric emission and the non-LTE central absorption. Most of the sample stars display a central absorption that is typically redshifted by ~0.1 km/s relative to the emission, but the nature of this velocity gradient remains unknown. The FWHM of the H and K lines increase with stellar luminosity, reminiscent of the Wilson-Bappu effect in FGK-type stars. Both the equivalent widths and FWHM exhibit modest temporal variability in individual stars. At a given value of M_v, stars exhibit a spread in both the equivalent width and FWHM of Ca II H and K, due both to a spread in fundamental stellar parameters including rotation rate, age, and possibly metallicity, and to the spread in stellar mass at a given M_v. The K line is consistently wider than the H line, as expected, and its central absorption is more redshifted, indicating that the H and K lines form at slightly different heights in the chromosphere where the velocities are slightly different. The equivalent width of H-alpha correlates with Ca II H and K only for stars having Ca II equivalent widths above ~2 angstroms, suggesting the existence of a magnetic threshold above which the lower and upper chromospheres become thermally coupled.Comment: 40 pages including 12 figures and 17 pages of tables, accepted for publication in PAS