Several Institute for Clinical Systems Improvement (ICSI) members, all six ICSI sponsors and the Department of Human Services (DHS) have initiated the Depression Improvement Across Minnesota Offering a New Direction (DIAMOND) Project.

The purpose of the DIAMOND Project is to identify a best practice model for depression care that is evidence-based and then propose options for implementing the model throughout the state.

"Many patients with depression are not given diagnosis codes for depression for multiple reasons and not managed the way they should be," said Nancy Jaeckels, ICSI director of Education and Resources for Improvement. "There’s strong evidence illustrating the models, strategies and business case for how to care for patients with depression. Now we need to figure out all the barriers, and work together from all aspects of health care to overcome the barriers and get best practices in place."

For example, using nurse and telephone intervention may be as good or better than an office visit, but not easily implemented due to staffing, appropriate training and coverage by health plans, according to ICSI Medical Director Gary Oftedahl, MD.

The DIAMOND Project group is identifying a new model for structuring and covering best practice for depression management and will start a pilot project in 2007 using principles from the chronic care model.
"This is revolutionary," Oftedahl said. "If this model works for depression, the learnings can be transferred to heart disease, diabetes and other chronic conditions."

A proposal to the National Institutes for Health (NIH) has been made to fund the evaluation of the project.