Objective This article describes the implementation of a population-based strategy to manage depression in a patient-centered medical home.

Methods Review of English language articles; description of specific protocols utilized in one medical home.

Results Depression is a global concern estimated to affect 350 million people worldwide. Rates for depression vary between the United States and the Peoples’ Republic of China, possibly due to significant factors in under diagnosis of this often hidden burden. Given the comorbidity of depression with other health factors and the need for ongoing monitoring and care of this chronic illness, primary care has become a significant part of treatment interventions. Utilizing electronic health records (EHR), our strategy included the creation of a patient registry; selection of evidence-based treatment guidelines and protocols for point of care procedures; patient outreach and screening.

Conclusion The population-based program we outline is highly dependent on the EHR and the flexibility of roles and responsibilities of clinical staff. Further investigation is warranted into improved patient outcomes.