Gary Oftedahl: DIAMOND to Denver–a week of transition
October 9, 2009
In past posts, I’ve spoken of the DIAMOND program for patients with depression, collaborative care, and moving from ideas to invention to innovation, as issues and efforts which have become a part of my world. This week, I was humbled by several events which have caused me to ponder, and personally reflect. First, I’ve not felt well. If I was a betting man, I’d suspect I’ve had the opportunity to experience the wonders of H1N1, or if not, something equally nasty. But as I struggled through a haze of Ibuprofen-induced comfort, it was also a week of excitement, advancement, new relationships, and potential support for the important work of ICSI and others in the health care environment.
On Monday, ICSI hosted a symposium on DIAMOND, our collaborative effort on improving depression in primary care in Minnesota (http://www.icsi.org/health_care_redesign_/diamond_35953/). More than 100 people from across the country spent the day becoming exposed to the depth and breadth of our efforts. Ed Wagner, from the MacColl Institute, keynoted the day, and highlighted the value and contributions of the efforts, in advancing the collaborative concepts initially described in his elegant chronic care model. Subsequent presentations from providers, care managers, psychiatrists, health plans, purchasers, and ICSI staff eloquently brought the conceptual framework described by Dr. Wagner to the concrete experiences at the front lines. The day concluded with remarks from the creator of the IMPACT model (on which DIAMOND was based), Jurgen Unutzer, encouraging future ongoing efforts.
As someone who has been intimately involved with the DIAMOND effort, it was not only a validating experience, but a humbling one in realizing that the efforts have truly impacted the lives and experiences of many. But perhaps the most compelling part of the day occurred in mid-afternoon, when two patients, not accustomed to the spotlight, bravely stood in front of the audience, and told their stories. Respectful of their privacy, I’ll only say that SB, a woman with a long history of depression and bipolar disorder, and MK, a young man truly representative of the “tough” male, reframed the conversation by relating their personal stories, and in some ways challenging the audience to move this to “the way we should treat depression.” MK humorously noted that he wasn’t particularly interested in what the audience was discussing, but only that he knew that the care manager who was introduced into his life as a part of the DIAMOND program, was directly responsible for his success in conquering his depression–not from the professionals whom often take the prominent role.
It was an exciting day, both in engaging others in learning about our work, and in identifying the challenges ahead. It energized many with whom we’ve worked, and provided an opportunity for them to share their successes. An outstanding day.
It’s now Friday, and I’ve spent the last 24 hours immersed in a round-table discussing the development of CCRN (Collaborative Care Research Network). This is an effort under the auspices of the AAFP (American Academy of Family Practice) using the PBRN (Practice Based Research Network) concept developed to investigate new approaches and applying it to the integration of mental/behavioral health into primary care–”collaborative care.” I’d written a blog about my evolving confusion about the lack of a common vocabulary/lexicon in much of the work we’re doing. Perhaps it is that confusion which led to them inviting me to a research agenda conference. Heaven knows I’m not a researcher in the traditional sense.
But while we’re still in the midst of the discussion, it has been both an eye opening, and invigorating discussion. I personally believe that the DIAMOND experience, now encompassing 60 clinics, and nearing 3,000 patients, provides a great framework from which to build on our knowledge of collaborative care. Not surprisingly, not everyone shares that opinion. But, as the discussion progresses, the energy, the passion, the commitment to finding a new way to deliver care to our citizens is obvious.
The cacophony of noise around health care reform continues. The differences of opinion occasionally raise the conversation to a confrontation rather than a dialogue. The history of separating the human condition into “mental” and “physical” health has created what I believe is an artificial model which has little resemblance to the reality of the individual’s need. From the evolution of the discussions this week, starting with the success and enthusiasm of the DIAMOND symposium, to the dialogue between a diverse set of voices addressing integrating mental/behavioral health into the primary care sector, I have hope. Perhaps it’s unfounded, perhaps it’s naive, but it’s only through challenging our traditional lenses on health care, and a willingness to move outside our personal and professional comfort zones that we’ll truly transform health care. This blog is premature as far as conclusions, but a reflection of a state of mind, hopefully to be supported by the discussions I’m now off to continue. And, what’s even better, the fog from the flu has cleared, even as the snow falls in the mountains of Colorado.
Entry Filed under: General Info, Health Care Redesign. .
