Improving Patient-Centered Care for Veterans With Treatment-Resistant Depression Using Shared Decision-Making Tools

Area of Science:

• Psychiatry
• Quality Improvement
• Healthcare Management

Background:

• Treatment-resistant depression (TRD) affects 50-60% of patients, with higher rates and comorbidities in military populations.
• A chart audit revealed 68% of veterans met TRD criteria, yet only 25% received adequate treatment, and none were offered alternatives.
• No standardized guidelines exist for TRD identification, complicating patient care.

Purpose of the Study:

• To enhance patient-centered TRD care within a veteran's hospital.
• To improve TRD care to 80% within 90 days.
• To implement and evaluate a quality improvement project for TRD management.

Main Methods:

• A quality improvement project utilizing plan-do-study-act (PDSA) cycles over 8 weeks.
• Four core interventions: TRD screening, right-care case management, shared decision-making (SDM), and team engagement.
• Rapid-cycle testing of improvements in screening, patient education, surveys, and team collaboration.

Main Results:

• Achieved an overall mean score of 99.6% for patient-centered TRD care.
• Exceeded the project's aim of 80% improvement within 90 days.
• Demonstrated significant improvement from a baseline right-care score of 25%.

Conclusions:

• Patient-centered TRD care was substantially improved through shared decision-making (SDM) and enhanced inter-clinic teamwork.
• The project successfully demonstrated a scalable model for improving TRD management in a veteran population.
• Effective teamwork and communication are crucial for optimizing treatment outcomes in TRD.