Learning Session

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Learning Session 2May 12-14, 2005Atlanta,
Georgia
South East Cluster
St. Joseph Care of Florida, Inc. Gulf County
Health Department Port St. Joe, Florida
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St Joseph Care of Florida, Inc./Gulf County
Health Department2475 Garrison AvenuePort St.
Joe, Florida

• We have 70 employees and 10 providers.
• Mental Health Patients
• Over one and a half years 225 patients
• Patients assessed and diagnosed for
  depression 172
• Active file of patients in PECS registry
  47
• The average number of patients seen in clinic is
  1200.

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Team Members

• Douglas Kent, COO, MPH
• Carol Sutton, MD
• Jill Jones, MSW
• Mary Warner, LCSW
• Dennis Huitt, IT Specialist

Team Leader Key Contact Info Jill Jones,
[phone] x -126 Jill_Jones_at_doh.state.fl.us
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AIM Statement

• AIM St Joseph Care of Florida will redesign the
  clinical practice to improve the care of our
  patients with depression by implementing the Care
  Model. We will increase the recognition rate of
  depression and implement an active follow-up
  program to enhance treatment. Our goals are to
  have current guidelines for care and referral
  consistently utilized by the practice. We will
  accomplish this by implementing the following
  measures

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Selected Measures

• 70 of patients diagnosed with depression will
  have a PHQ score completed on their chart.
• 70 of CSD patients with documented PHQ will be
  reassessed between 4-8 weeks of the last new
  episode PHQ.
• 40 of the patients will have a 50 improvement
  of PHQ score within 6 months.
• 70 of patients will have documented
  self-management goals set in the last 12 months.

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Community

• Currently Testing
• ? The increased collaboration of mental health
  services for patients of Gulf County.

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Healthcare Organization

• Currently Testing
• The Health Disparities Care Model will be
  incorporated into the St. Joseph Care of
  Florida/Gulf County Health Department Strategic
  Plan.
• Implemented into our Delivery System
• Continuous education of progress of collaborative
  will be given to the FQHC Board and overall staff
  monthly.

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Decision Support

• Currently testing
• A decision support tree will be implemented in
  clinic to identify and refer patients to LCSW.

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Clinical Information System

• Currently Testing
• The LCSW appointments will be scheduled by one
  specific front desk staff person into HCMS
  system.

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Delivery System Design

• Currently Testing
• The effectiveness of the PHQ-9 in identifying
  patients quickly and comprehensively for
  depression.

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Functional and Clinical Outcomes
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National Key Measures
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Additional Center Key Measures
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Senior LeadershipMaking the Case for Change

• What information did you share with your COO
  and/or Board of Directors to encourage them to
  make improvements in the management of
  Depression?
• Team members presented the Care Model to both
  the COO and FQHC Board resulting in the benefit
  of St. Joseph Care of Florida/Gulf County Health
  Department being a state-of-the-art facility. The
  COO stressed to the board, that means for
  reimbursement will be looked at in the near
  future based on patient improvement. Statistical
  data reinforces the concern for patients not
  identified and costs to the healthcare system.

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Senior Leadership

• How did you promote the work?
• The Gulf Health and Community Services
  Partnership is a body of service providers that
  meet quarterly to share information and progress
  of community programs. The local paper
  participates in the meetings and reports
  information in the paper. Team members have
  presented for the Kiwanis Club of Port St. Joe.
  The collaborative progress is also seen in the
  SJCF/GCHD newsletter, which is distributed
  locally and to the state office of Department of
  Health. Additionally , a team member was asked to
  present at the Nursing Director Conference in St.
  Augustine, FL regarding our work with the
  collaborative and implementation of the PHQ-9 in
  the clinic setting.

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Communication Plan

• At the center level The progress of the
  collaborative is presented to the overall staff
  in monthly meetings. Specific time has been set
  aside at overall staff meetings to speak with
  front desk, clinic and social services
  departments regarding updates of the
  collaborative. Additionally, information/updates
  are reported weekly in supervisor meetings.
  Email communication is also another means in
  reporting progress/barriers, etc.. of
  collaborative.

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Communication Plan

• At the community level The Gulf Health and
  Community Services Partnership is a large body of
  community and outlying service providers.
  Information is reported quarterly to the members.
  The local newspaper attends these meetings and
  summarizes information on program progresses
  within Gulf County. Presentation to civic groups
  and communication with other medical providers in
  the community continues. Recently, the COO was
  asked to sit on the board of Life Management,
  which is an outlying mental health service
  provider that serves Gulf County.

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Anticipating Barriers and Issues
Those that leadership needs to address
Those that the team can resolve

• Data integrity /registry training.
• Monthly education for staff

• Medical-Clinic staff buy-in
• Resources for medications
• Financial constraints.

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A story to share.the patient

• 82 year old male was referred to St. Joseph Care
  of Florida, Inc. by a provider in the community
  to assess dementia vs. pseudo-dementia. Pt
  presented with apraxia, unsteady gait, negative
  view of the world and future. Pt multiple recent
  losses in particular, the loss of his devoted
  daughter to breast cancer. Pt was tremulous,
  isolating himself at home, and frustrated with
  systems. Pts PHQ-9 was 10. Pt completed 9 months
  of psycho-therapy and remained in remission x 3
  months with his last PHQ score of 0. Pt was able
  to facilitate and organize a burial at sea for
  his daughter, he started socializing and playing
  golf. Pt was able to write without difficulty and
  even started his own photography business of
  beautiful sunsets on the Gulf Coast. Most
  importantly, this pt is able to stay in the
  present and enjoy himself as well as looking
  forward to future days.

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A story to share.our staff

• PHQ-9
• During the last two months, our staff has
  experienced some unexpected change The local
  county hospital shut down and all their clinic
  patients were diverted to the Gulf County Health
  Department. This increased workload placed a
  great deal of stress on the staff. At the same
  time, the Team Leader and the Clinical/Tech were
  trying to approach the already over-worked staff
  to administer the PHQ-9 to patients in the
  clinic. It was finally agreed upon to place the
  PHQ-9 on all the charts that were scheduled for
  physicals. After the first day, a couple of
  patients were identified with depression and two
  of the nursing staff stated that it was not
  difficult as the assessment is self-administered.
  This was a milestone. The next PDSA will be to
  place the PHQ-9 on every chart during the morning
  hours on certain days.

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A story to share.the organization

• Department of Health Public Health Nurses
  Conference
• Our Clinical/Tech, Licensed Clinical Social
  Worker was asked to speak at the Public Health
  Nurses Conference which is addressing assessment
  for depression in community and county health
  departments. Because there has been a rise in
  suicides during this last year especially in
  Northern Florida, the Governor of the State, Jeb
  Bush, wants the conference to focus on early
  intervention and assessment. Our clinical/Tech
  and our IS specialist were able to create a power
  point presentation utilizing the PHQ-9 and the
  Suicide Risk Assessment Form as well as
  techniques for crisis intervention and Cognitive
  Therapy. The power point provides contact
  information for the Bureau of Primary Health Care
  Health Disparities Collaborative. Hopefully, we
  will educate more health departments on assessing
  for mental health in the medical setting.