November 29, 2021

Life Goals Collaborative Care for Bipolar Disorder

Building a Learning Health System

Amy Kilbourne, Ph.D.

For the past 20 years, Amy Kilbourne, Ph.D., Celeste Liebrecht, LMSW and Mark Bauer, M.D., of Harvard Medical School, have implemented innovative models of care for bipolar and other mood disorders, especially in underserved communities. This work is now informing the next generation of evidence-based care implementation through Learning Health Systems (LHS). Despite the availability of treatments, few with bipolar disorder receive adequate quality of care.

This leads to substantial functional impairment and premature mortality — especially from suicide and cardiovascular disease. LHS helps patients, providers and health systems improve outcomes through formation of a learning community that generates comprehensive data to gather knowledge and implement care improvements. This will ultimately inform ongoing inquiry and discovery that moves the needle on high-quality, equitable, patient centered care.

Dr. Kilbourne’s Life Goals Collaborative Care (LGCC) model aligns care management with self-management and clinical decision support to create an LHS. Several randomized trials showed- that LGCC improves both physical and mental health outcomes in persons with mood disorders. Groundbreaking research on LGCC in the U.S. Department of Veterans Affairs led to the Life Goals toolkit and mobile app. Currently, Dr. Kilbourne is implementing LGCC across Michigan and Maryland with Gail Daumit, Ph.D. (Johns Hopkins University) funded by the NIH. The Michigan collaborative team includes Celeste Liebrecht, LMSW, Brianna Osorio, MS, Department of Learning Health Sciences (DLHS), Shawna Smith, Ph.D., School of Public Health, and Daniel Almirall, Ph.D., Institute for Social Research. Dr. Kilbourne is working closely with the Prechter Program to integrate a learning health systems approach.