Having a Real IMPACT on Depression
by Chris Langston
Tuesday, October 13, 2009 12:30
A common complaint about philanthropy is that it lacks the focus and patience to provide sufficient resources over enough time to have a realistic chance of achieving social change. In other words, in the garden of social innovation we are accused of sprinkling our resources too lightly, producing a garden full of stunted, dwarf innovations that lack the reach and depth to match our social needs.
Therefore, it is a proud moment to be able to report that after more than 12 years of work, Project IMPACT, the primary- care-based model of depression treatment that doubles the benefits of usual care, has graduated the 3,500th person from its series of training workshops. The map below shows in blue the states where the project team, led by Jürgen Unützer at the University of Washington, have planted their model.
It seems only yesterday that we set “stretch” goals for the dissemination effort, including making contact with 1,000 potential adopters, engaging 500 in serious consideration of implementing the model, and yielding 250 to actually make change. The experience of the IMPACT team has taught us all a great deal about the realities of moving even from highly applied health services research to widespread change in how health care professionals provide routine care. We expect to be able to apply these lessons in our own future grantmaking and in the emerging national conversation swirling around the concepts of dissemination, implementation, scale-up, and transfer.
We would also love to hear from other foundations and grantees: What strategies helped you successfully disseminate your programs?
Jurgen Unutzer says:
October 19th, 2009 at 2:27 am
Over the past 5 years, we have been fortunate to have support from the John A. Hartford Foundation to train 3,500 individuals in more than 200 health care practices in the United States and abroad in the IMPACT program (http://impact-uw.edu). As a group of academicians, we have learned many lessons about moving from science to practice.
1. It can take more time, skills, and resources to effectively disseminate an evidence-based intervention than to develop and test it in the first place.
2. Implementers need more than facts published in peer reviewed journal articles. They need support with adapting the ideas and approaches tested in research studies into their own settings of care and with the practice change that is invariably required to implement such evidence-based approaches in diverse health care settings. They also need stable sources of funding for changing their practices to accommodate and implement new programs and for sustaining these programs in the long run.
3. Academic medical centers are not well prepared to provide this kind of ‘real world’ translation and implementation support. To address this limitation, we have developed a number of strategic partnerships with organizations well positioned to help translate inventions from research to large scale practice change. One outstanding example is a partnership we have developed with the Institute for Clinical Systems Research (ICSI) in Minnesota. ICSI has taken the ideas we tested in IMPACT and created a state-wide initiative called DIAMOND (Depression Improvement Across Minnesota: a New Direction; see http://www.icsi.org/health_care_redesign_/diamond_35953/ ).
This partnership involves several large Minnesota Health Plans who have agreed on a new case-rate payment mechanism to finance this evidence-based model of depression care and over 20 large Medical Groups who have agreed to train staff in this new model of care. Working closely with experts at the IMPACT Implementation Center, ICSI has developed a superb program to provide the training, technical assistance, and implementation support required to implement this program with over 500 primary care physicians in more than 80 primary care clinics around the state of Minnesota.
Chris Langston says:
October 19th, 2009 at 9:47 am
As usual, Dr. Unutzer is far too modest. Not only is IMPACT one of the most successful planed changes in health care systems, but in the University of Washington’s new AIMS Center (Advancing Integrated Mental-Health Solutions), Jurgen and his colleagues plan to use what they have learned to support the translation of a wide range of evidence-based integrated care models into general practice. It is an ambitious goal, reported last month to the membership of Grantmakers in Health (http://www.gih.org/usr_doc/Integrated_MH_Care_Overview_for_GIH_Sept_2009.pdf). At the Hartford Foundation we are very proud to be affiliated with this work.