Building a system of perfect depression care in behavioral health.
BACKGROUND
Depression, a common, serious disorder, may result in suicide in up to 10% of afflicted persons.


METHODS
In 2001, the Division of Behavioral Health Services of the Henry Ford Health System (Detroit) launched an initiative to completely redesign depression care delivery using the Six Aims and the Ten Rules from the Institute of Medicine report Crossing the Quality Chasm. This "Perfect Depression Care" initiative, whose key goal was the elimination of suicide, entailed performance improvement activities in four domains-partnership with patients, clinical care (planned care model), access, and information flow.


RESULTS
The rate of suicide in the patient population decreased by 75% (p = .007), from approximately 89 per 100,000 at baseline (2000) to approximately 22 per 100,000 for the four-year follow-up interval (the average rate for 2002-2005).


CONCLUSIONS
This sustained reduction in suicide rate suggests that the process improvements implemented as part of the Perfect Depression Care initiative substantially improved the care of persons with depression. The initiative is the prototype for a comprehensive redesign of behavioral health care. Work is under way to "perfect" the care of persons with anxiety or psychotic disorders, and similar care systems are being developed for violence prevention and medication safety, with a particular focus on perfecting communication between providers. Pursuing perfection is no longer a project or initiative but a principle driving force embedded in the fabric of our care.
Coffey
C Edward
CE
Henry Ford Health System, Detroit, USA. ecoffey1@hfhs.org
D001363:Awards and Prizes; D003156:Community Mental Health Services / Q000379:methods* / Q000458:organization & administration; D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration; D003865:Major Depressive Disorder / Q000628:therapy*; D016304:Hospitals, Private; D006801:Humans; D008824:Michigan; D009936:Organizational Innovation; D010347:Patient Care Planning; D017060:Patient Satisfaction; D000092864:Suicide Prevention