DEPRESSION AND WORK PRODUCTIVITYRebecca Rossom, MD, MSCRHealthPartners Research Foundation

DIAMOND STUDY Landmark example of partnership research Parallel study designed to provide a detailed

evaluation of this unique initiative 5-year NIH-funded study Study questions developed collaboratively

with DIAMOND initiative stakeholders Goal:

to use a partnership between medical groups, health plans, and researchers to study the impact of this new collaborative care model

DIAMOND STUDY GOALS Specific aims:

Identify effects of facilitated organizational change on Use and sustainability of the care process

Depression symptoms, healthcare costs, productivity

Identify organizational factors that affect implementation and effects of care changes

Describe reach, adverse outcomes, adoption and implementation to evaluate potential for broader scale dissemination

DIAMOND STUDY GOALS Compare depression care before/after Compare patient outcomes before/after

Depression Severity Quality of Life Patient satisfaction Work Productivity

Compare healthcare use/costs before/after

Measure costs/problems with implementation

Learn which practice systems are most important

PREVIOUS STUDIES Have proven the efficacy of the model, but in

a controlled setting with research funding

Have not: Tested the model with traditional health care

funding sources Quantified productivity gains Described implementation costs and success

factors in a non-controlled setting

DIAMOND STUDY DESIGN:STAGGERED IMPLEMENTATION

2008 2009 2010

Seq

F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D

1

2

3

4

5

BEFORE & AFTER STUDY DESIGN

Usual Care

New Care

Intervention

MeasurePatient &

Care SystemOutcomes

MeasurePatient & Care

SystemOutcomes

DEPRESSION & WORK PRODUCTIVITY 88 clinics representing 23 medical groups

Pre-implementation for DIAMOND (usual care)

Inclusion criteria: 18+ years old Newly started on antidepressant Did not opt out PHQ-9 >7 (at least mild depression) Working at least part-time

PATIENT ENROLLMENT

DEMOGRAPHIC CHARACTERISTICS (N=771)

DEPRESSION SEVERITYSeverity (PHQ-9 score) N %Mild (7-9) 263 34%Moderate (10-14) 292 38%Moderate-to-Severe (15-19) 159 21%Severe (20+) 57 7%

Notes:•Major depression : PHQ-9 > 15•Mean PHQ-9 = 12.2 (SD 4.3)

ABSENTEEISM AND PRESENTEEISM

ABSENTEEISM% WORK TIME LOST IN PAST 7 DAYS DUE TO HEALTH

PRESENTEEISM% WORK TIME IMPAIRED IN PAST 7 DAYS DUE TO HEALTH

ABSENTEEISM + PRESENTEEISM = PRODUCTIVITY LOST

DEPRESSION SEVERITY & PRODUCTIVITY

SUMMARY Even minor depression is associated with work

impairment More severe depression is associated with a

greater loss of productivity In relative terms, presenteeism due to

depression may represent a more significant problem than absenteeism for employers

Other studies have shown that high-quality depression treatments are cost-effective and improve symptoms and work function; employers may find it beneficial to invest in treatment for depressed employees across the continuum of depression severity