POPULATION BASED MANAGEMENT OF DEPRESSION

基于人群的抑郁症管理

• 批准号: 2675143
• 负责人: GREGORY G SIMON
• 金额: $ 32.23万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-06-01 至 2000-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2675143
• 关键词: antidepressants; clinical research; drug administration rate /duration; functional ability; health care cost /financing; health care personnel performance; health care service utilization; human data; human morbidity; human subject; interview; longitudinal human study; major depression; managed care; mental disorder chemotherapy; mental disorder diagnosis; mental health epidemiology; mental health information system; patient /disease registry; patient care management; pharmacy administration; population survey; relapse /recurrence

DESCRIPTION (Adapted from applicant's abstract): Among patients treated for depression in primary care, few receive recommended intensity of treatment. Delivery of appropriate acute-phase treatment to depressed primary care patients would significantly improve clinical outcomes. Our previous research, however, suggests that inadequate treatment is more a consequence of inadequate practice organization and follow-up than deficits in provider knowledge. Effective quality improvement must assure appropriate follow-up care and improve treatment adherence. Key ingredients of a systematic practice improvement program include: "real time" monitoring of care processes, systematic assessment of outcomes, continuous feedback to providers, and support for outreach to patients who discontinue treatment prematurely. This proposal describes a randomized evaluation of such a population-based quality improvement program for depressed primary care patients. We will enroll approximately 45 primary care practices at Group Health Cooperative (a staff-model HMO) and randomize practices to 3 groups. In the "usual care" group, physicians and patients will receive no specific intervention services. In the "process feedback only group", physicians will receive reports on the progress of patients currently receiving acute-phase antidepressant treatment (medication adherence, follow-up visit frequency, specialty mental health treatment, recommendations for changes in treatment). In the "process/outcome feedback plus practice support" physicians will receive the above reports as well as data on clinical response to treatment. Physicians in this group will also be supported by a "population manager" who will assist in contacting patients to assure appropriate follow-up. A sample of patients treated by participating physicians (approximately 250 per group) will be contacted for independent, blinded assessment of clinical and functional outcomes 3 and 6 months after initiating treatment. HMO data systems will be used to assess medication use, follow-up visit frequency, and costs of care. Each of the intervention groups will be compared to the usual care group in terms of quality of care, clinical outcomes, functional outcomes, and treatment costs.

描述（改编自申请人摘要）：在接受以下治疗的患者中 在初级保健中，很少有人接受推荐的治疗强度。 对抑郁症的初级护理提供适当的急性期治疗 患者将显著改善临床结果。 我们以前的 然而，研究表明，不适当的治疗更多的是一个后果， 不充分的实践组织和后续行动比赤字提供者 知识 有效的质量改进必须确保适当的后续行动 护理和提高治疗依从性。 一个有系统的 实践改进方案包括：“真实的时间”监测护理 过程，系统评估结果，持续反馈， 提供者，并支持对停止治疗的患者进行外展 过早地。 该提案描述了对这种 以人口为基础的抑郁症初级保健质量改进计划 患者 我们将在集团招募约45名初级保健实践者， 健康合作社（一个工作人员模式的HMO）和随机做法3组。 在“常规护理”组中，医生和患者将不接受任何特定的治疗。 干预服务。 在“仅过程反馈组”中， 将收到关于目前正在接受 急性期抗抑郁治疗（药物依从性，随访访视 频率，专业心理健康治疗，建议改变 治疗）。 在“过程/结果反馈加实践支持”中， 医生将收到上述报告以及临床数据， 对治疗反应。 该小组的医生也将得到一个 “人口管理员”将协助联系患者， 适当的后续行动。 通过参与治疗的患者样本 将联系医生（每组约250名）， 对术后3个月和6个月的临床和功能结局进行盲态评估 开始治疗 HMO数据系统将用于评估药物 使用、随访频率和护理费用。 每次干预 在护理质量方面将各组与常规护理组进行比较， 临床结果、功能结果和治疗成本。