Outcomes of Depression and Anxiety in a Virtual Collaborative Care Program: A Quality Improvement Study

Behavioral health conditions affect a substantial proportion of the United States population each year, yet many individuals do not receive treatment due to multiple barriers. The Clinically Optimal Access to Collaborative Healthcare (COACH) program is a virtual implementation of the Collaborative Care Model (CCM) that addresses these barriers.

This was a retrospective study evaluating the outcomes of a QI project aimed at improving the care of patients with major depressive disorder (MDD) and/or generalized anxiety disorder (GAD) through enrollment into the COACH Program from Nov 1, 2021, to Oct 31, 2024. Patient Health Questionnaire-9 (PHQ-9), GAD-7 scores, and demographics were collected from electronic medical records at baseline and 3 and 6 months after enrollment in the COACH program. Remission and attrition rates were calculated at 3 and 6 months. A phase analysis over 18 months was conducted of PHQ-9 and GAD-7 mean scores before and after enrollment in the COACH program A paired t-test was used to assess changes in scores from baseline to follow-up, with statistical significance set at p < 0.05, using SPSS.

A total of 531 patients were included in the analysis (median age 45 y, 50% White, 27% Hispanic). Most patients were referred from primary care provider (PCP) offices (95%) and spoke English (99%). Fifty-four percent (n = 284) had MDD as a primary diagnosis, and 75% (n = 211) had GAD as a secondary diagnosis. By 3 months, 32% with MDD and 40.1% with GAD achieved remission with an overall attrition of 26%. Over 18 months, the phase analysis showed that post-intervention mean monthly PHQ-9 and GAD-7 scores dropped from 11.8 to 7.5 and 10.8 to 6.4, respectively, indicating a shift in the process, which was statistically significant (p < 0.001 and < 0.0001, respectively).

The care provided using the COACH Program was associated with a reduction in depression and anxiety symptoms at 3 and 6 months, achieving significant remission rates, while maintaining good patient engagement. The COACH program, as an iteration of the collaborative care model, presents an alternative for the traditional delivery of care for anxiety and depression.