The COMPASS initiative: description of a nationwide collaborative approach to the care of patients with depression and diabetes and/or cardiovascular disease

Gen Hosp Psychiatry. Jan-Feb 2017;44:69-76. doi: 10.1016/j.genhosppsych.2016.05.007. Epub 2016 Aug 22.


Objective: To describe a national effort to disseminate and implement an evidence-based collaborative care management model for patients with both depression and poorly controlled diabetes and/or cardiovascular disease across multiple, real-world diverse clinical practice sites.

Methods: Goals for the initiative were as follows: (1) to improve depression symptoms in 40% of patients, (2) to improve diabetes and hypertension control rates by 20%, (3) to increase provider satisfaction by 20%, (4) to improve patient satisfaction with their care by 20% and (5) to demonstrate cost savings. A Care Management Tracking System was used for collecting clinical care information to create performance measures for quality improvement while also assessing the overall accomplishment of these goals.

Results: The Care of Mental, Physical and Substance-use Syndromes (COMPASS) initiative spread an evidence-based collaborative care model among 18 medical groups and 172 clinics in eight states. We describe the initiative's evidence-base and methods for others to replicate our work.

Conclusions: The COMPASS initiative demonstrated that a diverse set of health care systems and other organizations can work together to rapidly implement an evidence-based care model for complex, hard-to-reach patients. We present this model as an example of how the time gap between research and practice can be reduced on a large scale.

Keywords: Cardiovascular disease; Collaborative care; Depression; Implementation; Integrated behavioral health.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / therapy*
  • Comorbidity
  • Delivery of Health Care, Integrated / organization & administration*
  • Depression / epidemiology
  • Depression / therapy*
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / therapy*
  • Evidence-Based Practice / organization & administration*
  • Humans
  • Intersectoral Collaboration*
  • Program Development*