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