An Information tecHnology approach to implEmenting depression treAtment in caRdiac patienTs: [iHeart Trial]

对心脏病患者实施抑郁症治疗的信息技术方法：[iHeart 试验]

• 批准号: 10375522
• 负责人: Nathalie Moise
• 金额: $ 75.36万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10375522
• 关键词: Ambulatory Care; American Heart Association; Antidepressive Agents; Back; Behavioral; Cardiac; Cardiovascular Diseases; Caring; Clinic; Clinical Trials; Communication; Coping Skills; Coronary heart disease; Counseling; Data; Depressed mood; Depression screen; Diagnosis; Disease; Disease remission; Electronic Health Record; Enrollment; Event; Failure; Feedback; Focus Groups; General Population; Goals; Guidelines; Healthcare Systems; Hospitals; Human Resources; Information Technology; International; Intervention; Mental Depression; Motivation; New York; Outcome; Outpatients; Patient Preferences; Patients; Physicians; Population; Presbyterian Church; Prevalence; Primary Health Care; Process; Provider; Public Health; Quality of life; Randomized Controlled Trials; Recommendation; Recurrence; Reporting; Research; Risk; Site; Surveys; Survivors; Symptoms; System; Testing; Time; Visit; Work; acute coronary syndrome; care providers; clinically significant; collaborative care; comorbidity; cost; data format; depressive symptoms; design; effectiveness evaluation; effectiveness testing; implementation intervention; implementation process; implementation science; implementation strategy; improved; innovative technologies; mortality; mortality risk; multi-component intervention; post implementation; primary care setting; primary outcome; programs; screening; screening guidelines; secondary outcome; shared decision making; social stigma; systematic review; theories; tool; treatment adherence; treatment guidelines; uptake

The goal of this proposal is to test whether a theory-informed multicomponent intervention involving an electronic shared decision making (eSDM) tool (iHeart Trial) can increase the uptake of depression treatment following acute coronary syndromes (post-ACS). Depression is three times more common in depressed post- ACS patients than the general population and doubles the risk of recurrent cardiac events and mortality. Depression treatment can improve debilitating depressive symptoms and quality of life. Multiple scientific groups recommend screening for depression and treating when indicated in post-ACS patients. Despite decades of observational data and expert guidelines, only 30% of depressed post-ACS patients receive treatment, far lower than the treatment rates seen in the general depression population. This proposal is a culmination of years of work with multiple study sites, innumerable patients, IT personnel and experts in depression and cardiovascular disease. We reviewed systematically all interventions targeting depression treatment engagement in primary care settings. We conducted a nationwide survey of 352 depressed post-ACS patients. We ran behavioral and primary care provider focus groups to ascertain barriers to depression treatment in primary care in 8 healthcare systems that had implemented depression screening and treatment. We learned that key barriers to depression treatment are (1) suboptimal rates of depression recognition and referral by providers and (2) dismissal of the importance of depressive symptoms and lack of ability to choose type of depression treatment by patients. Using these formative data, we applied a theory- informed process of engaging stakeholders to select an acceptable, feasible intervention and determined that eSDM would target the greatest number of barriers to implementing patient preferred depression treatment in post-ACS patients. We subsequently developed and alpha tested an iPad delivered, video-assisted, interactive eSDM tool that aims to reduce barriers to depression treatment in cardiac patients. We hypothesize that this state-of-the-art, theory-driven eSDM tool that automates the SDM process, activates providers, staff, and patients and interfaces with the electronic health record will improve implementation of depression guidelines in post-ACS patients with persistently elevated depressive symptoms. We propose to conduct a stepped wedge trial across 8 primary care clinics to assess the effectiveness of our eSDM tool on depressive symptoms (primary outcome) and depression treatment uptake (Aim 1) and implementation processes such as depression screening and treatment referral (Aim 2). Key outcomes will be rigorously assessed amongst 368 depressed post-ACS patients. Our study has the potential to produce a theory-informed, scalable eSDM tool that improves the implementation of post-ACS depression guidelines.

这项建议的目的是测试是否一个理论知情的多成分干预， 电子共享决策（eSDM）工具（iHeart Trial）可以增加抑郁症治疗的使用 急性冠状动脉综合征（ACS后）。抑郁症在抑郁症患者中的发病率是正常人的三倍， ACS患者比一般人群心脏事件复发和死亡的风险高一倍。 抑郁症治疗可以改善衰弱的抑郁症状和生活质量。多个科学 研究小组建议对ACS后患者进行抑郁筛查和治疗。尽管 根据数十年的观察数据和专家指南，只有30%的ACS后抑郁患者接受了 治疗，远远低于一般抑郁症人群的治疗率。 该提案是多年来与多个研究中心、无数患者和IT人员合作的成果 抑郁症和心血管疾病的专家。我们系统地审查了所有针对 抑郁症治疗参与初级保健设置。我们在全国范围内对352人进行了调查 ACS后抑郁的患者我们运行了行为和初级保健提供者焦点小组，以确定障碍 在8个已实施抑郁症筛查的医疗保健系统中， 和治疗。我们了解到，抑郁症治疗的关键障碍是（1）抑郁症的次优率 提供者的承认和转介，以及（2）忽视抑郁症状的重要性和缺乏 患者选择抑郁症治疗类型的能力。利用这些数据，我们提出了一个理论- 使利益攸关方参与选择可接受的可行干预措施的知情过程，并确定 eSDM将针对实施患者首选抑郁症治疗的最大障碍， ACS后患者我们随后开发并测试了一款iPad交付，视频辅助， 这是一个交互式eSDM工具，旨在减少心脏病患者治疗抑郁症的障碍。 我们假设，这种最先进的，理论驱动的eSDM工具，自动化的SDM过程， 激活提供者、工作人员和患者，并改善与电子健康记录的接口 抑郁指南在ACS后抑郁症状持续升高患者中的实施。 我们建议在8间基层医疗诊所进行一项阶梯式楔形试验，以评估 关于抑郁症状（主要结局）和抑郁治疗接受率（目标1）的eSDM工具，以及 实施过程，如抑郁症筛查和治疗转介（目标2）。主要成果将是 在368名ACS后抑郁患者中进行了严格评估。我们的研究有可能产生一个 一个理论性的、可扩展的eSDM工具，可改善ACS后抑郁症指南的实施。

项目成果

Time-Varying Depressive Symptoms and Cardiovascular and All-Cause Mortality: Does the Risk Vary by Age or Sex?

• DOI: 10.1161/jaha.120.016661
• 发表时间: 2020-10-20
• 期刊: Journal of the American Heart Association
• 影响因子: 5.4
• 作者: Bryant KB;Jannat-Khah DP;Cornelius T;Khodneva Y;Richman J;Fleck EM;Torres-Deas LM;Safford MM;Moise N
• 通讯作者: Moise N

Increasing Uptake of Depression Screening and Treatment Guidelines in Cardiac Patients: A Behavioral and Implementation Science Approach to Developing a Theory-Informed, Multilevel Implementation Strategy.

• DOI: 10.1161/circoutcomes.122.009338
• 发表时间: 2022-11
• 期刊: CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES
• 影响因子: 6.9
• 作者: Reuter, Katja;Genao, Kirali;Callanan, Emily M.;Cannone, Diane E.;Giardina, Elsa-Grace;Rollman, Bruce L.;Singer, Jessica;Slutzky, Amy R.;Ye, Siqin;Duran, Andrea T.;Moise, Nathalie
• 通讯作者: Moise, Nathalie

Differences in the Prevalence of Screen-Detected Depression After Acute Coronary Syndrome Between Health Systems in the USA: Findings from CODIACS-QoL Randomized Controlled Trial.

美国卫生系统之间通过屏幕检测到的急性冠脉综合征后抑郁症患病率的差异：CODIACS-QoL 随机对照试验的结果。

• DOI: 10.1007/s11606-021-07049-0
• 发表时间: 2022
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Moise,Nathalie;Davidson,KarinaW;Clarke,GregoryN;Dolor,RowenaJ;Margolis,KarenL;Kronish,IanM
• 通讯作者: Kronish,IanM