Bypassing the Blues is a National Heart Lung Blood Institute (NHLBI)-funded effectiveness trial conducted through the University of Pittsburgh's Center for Research on Health Care. It was designed to examine the impact of a telephone-delivered collaborative care strategy for treating depression after coronary artery bypass graft (CABG) surgery on a broad variety of outcome measures that could influence uptake of our treatment strategy into routine clinical care.
CABG surgery is one of the most common and costly medical procedures performed in the U.S., and it clearly benefits most patients. However, up to half of post-CABG patients report elevated levels of depressive symptoms following surgery, and studies indicate these individuals are more likely to experience poorer health-related quality of life, continued chest pains, and higher risk of re-hospitalization and death.
Numerous clinical trials have demonstrated the effectiveness of collaborative care strategies at improving clinical outcomes for major depression in primary care settings, yet Bypassing the Blues is the first to examine the impact of collaborative care for depression in a population with cardiac disease. To promote adoption of our methods by health care providers, we utilized the PHQ-9 and a clinically-efficient two-step method recommended by the American Heart Association to identify patients with elevated levels of depressive symptoms following CABG surgery, and centralized nurse care managers who delivered collaborative care via telephone to patients and their primary care physicians.
As described in the Journal of the American Medical Association, the Bypassing the Blues treatment model can significantly speed recovery following CABG surgery. Moreover, economic analyses recently published in General Hospital Psychiatry reported that patients randomly assigned to the intervention had $2,068 lower median Medicare and other private insurance claims at 12-months following bypass surgery than patients randomized to their doctors' usual care even after including the $460 average cost to deliver the Bypassing the Blues intervention ($16,126 vs. $18,194). Our nurse-provided and telephone-delivered intervention was also highly cost-effective, producing more quality-adjusted life-years (QALY) while significantly lowering medical claims costs by $9,889 per additional QALY generated, a first for a collaborative care strategy to treat depression in any patient population.
"One of the holy grails in mental health services research is to demonstrate that treating a common mental health condition such as depressionis not only effective and cost-effective, but is also cost-saving. This is the first trial to demonstrate all three outcomes. An American Heart Association science advisory already recommends routine screening and treatment of depression in patients with cardiac disease," said Dr. Bruce L. Rollman, the study principal investigator. "We now know that screening for and then providing effective depression treatment to patients with cardiovascular disease is not only effective and cost-effective, but also very likely to pay for itself."