A cluster randomized trial of standard quality improvement versus patient-centered interventions to enhance depression care for African Americans in the primary care setting: study protocol NCT00243425
A cluster randomized trial of standard quality improvement versus patient-centered interventions to enhance depression care for African Americans in the primary care setting: study protocol NCT00243425
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DOI：
10.1186/1748-5908-5-18
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发表时间：
2010-02-23
影响因子：
7.2
通讯作者：
Wang, Nae-Yuh
中科院分区：
文献类型：
--
作者：
Cooper, Lisa A.;Ford, Daniel E.;Wang, Nae-Yuh
背景：一些研究记录了非裔美国人在获得抑郁症护理和护理质量方面的差异。研究表明，患者的态度和临床医生的沟通行为可能会导致这些差异。有证据表明，以患者为中心的护理与心理健康结果的改善有关;因此，提高护理质量的干预措施是改善非裔美国人抑郁症治疗和结局的有希望的策略。本文介绍了BRIDGE（黑人接受抑郁干预和获得权力）研究的设计。该研究的目的是比较两种干预措施对非裔美国抑郁症患者的有效性-标准质量改善计划和以患者为中心的质量改善计划。主要假设是，与标准组相比，以患者为中心组的患者在6个月、12个月和18个月时的抑郁症状减轻程度更大，抑郁缓解率更高，心理健康功能改善程度更大。这项研究还探讨了患者的护理和接收的指南一致的治疗depression.Methods/Design：共36初级保健临床医生和132名非洲裔美国人的患者与抑郁症被招募到一个集群随机试验。该研究使用意向治疗分析来比较标准质量改进干预措施的有效性（为临床医生和患者提供以疾病为导向的护理管理的抑郁症指南的学术细节）和以患者为中心的质量改进干预措施（沟通技能培训，以加强临床医生和护理管理的参与性决策，重点是解释模型，社会文化障碍，讨论：BRIDGE研究包括临床医生和非裔美国人患者在资源不足的社区为基础的做法谁没有很好的代表性，在临床试验中，以改善抑郁症护理。以患者为中心和以文化为目标的抑郁症护理方法是一种相对较新的方法，尚未在大多数以前的研究中进行过测试。这项研究将提供证据，证明以患者为中心的住宿是否能在更大程度上提高非裔美国人抑郁症患者的护理质量和结果。
Background: Several studies document disparities in access to care and quality of care for depression for African Americans. Research suggests that patient attitudes and clinician communication behaviors may contribute to these disparities. Evidence links patient-centered care to improvements in mental health outcomes; therefore, quality improvement interventions that enhance this dimension of care are promising strategies to improve treatment and outcomes of depression among African Americans. This paper describes the design of the BRIDGE (Blacks Receiving Interventions for Depression and Gaining Empowerment) Study. The goal of the study is to compare the effectiveness of two interventions for African-American patients with depression-a standard quality improvement program and a patient-centered quality improvement program. The main hypothesis is that patients in the patient-centered group will have a greater reduction in their depression symptoms, higher rates of depression remission, and greater improvements in mental health functioning at six, twelve, and eighteen months than patients in the standard group. The study also examines patient ratings of care and receipt of guideline-concordant treatment for depression.Methods/Design: A total of 36 primary care clinicians and 132 of their African-American patients with major depressive disorder were recruited into a cluster randomized trial. The study uses intent-to-treat analyses to compare the effectiveness of standard quality improvement interventions (academic detailing about depression guidelines for clinicians and disease-oriented care management for their patients) and patient-centered quality improvement interventions (communication skills training to enhance participatory decision-making for clinicians and care management focused on explanatory models, socio-cultural barriers, and treatment preferences for their patients) for improving outcomes over 12 months of follow-up.Discussion: The BRIDGE Study includes clinicians and African-American patients in under-resourced community-based practices who have not been well-represented in clinical trials to improve depression care. The patient-centered and culturally targeted approach to depression care is a relatively new one that has not been tested in most previous studies. The study will provide evidence about whether patient-centered accommodations improve quality of care and outcomes to a greater extent than standard quality improvement strategies for African Americans with depression.