A System for Management of Depression in Medical Illness

描述(由申请人提供)：这项干预和实践研究基础设施支持计划(IP-RISP)申请寻求资金，以支持概念、方法和组织发展，以促进患有慢性内科疾病的初级保健患者的抑郁症干预研究。由过去和正在进行的工作形成的拟议开发活动将使调查人员能够通过使用新的概念、测量和统计工具以及通过创建在患者一级整合的信息系统来促进对内科疾病患者抑郁的了解。IP RISP的资金将使我们能够继续发展我们自1995年以来一直追求的重要目标，并代表这一应用程序的独特优势。我们在以下四个与这一应用相关的领域取得了重要进展：1)将精神卫生研究活动整合到HPHC的临床管理和战略规划活动中；2)设计创新的干预措施，为抑郁的高风险初级保健人群提供精神卫生服务；3)开发新的统计理论应用于结果评估和质量衡量；4)在护理网络模式中接触到大量临床人口，使我们能够在现实世界中进行研究。通过以下具体活动，实现基础设施建设目标。 1.我们将开发一个针对初级保健环境中患有抑郁症的内科病人的信息技术疾病管理系统(ITEMSD)，其中将包括一个报告和提醒疾病管理人员有关潜在护理差距的系统；一个疾病管理人员指南和文件系统，建议应采取的行动；一个疾病管理人员向其他工作人员和提供者传达患者评估、警报和采取行动的系统。消费者的喜好将通过使用标准的定性方法纳入项目-D的设计中。 2.该小组将培训疾病管理人员社会学习理论(SLT)的原则，作为项目D的理论基础，特别是其自我效能结构。 3.研究小组将与HPHC首席信息官和技术供应商Perot Systems合作设计Items-D数据库，以便将其轻松集成到HPHC的所有患者级别的信息系统中，以便于快速访问患者数据。 4.基础设施发展将用于利用项目D进行与基础设施发展以及开发RO1、R21和其他赠款申请有关的试点研究。研究团队与HPHC的临床领导层合作的经验和人才将使我们能够继续建设能力，在患有抑郁症的人群中开发抑郁症干预研究。我们预计，项目D的开发将满足医疗保健提供系统的需求，并作为启动未来干预措施的平台，从患有内科疾病的人群开始，但扩展到其他患有抑郁症和其他常见精神障碍的高风险群体。

DESCRIPTION (provided by applicant): This Intervention and Practice Research Infrastructure Support Program (IP-RISP) application seeks funding to support conceptual, methodological, and organizational development to foster depression intervention research among primary care patients with chronic medical illness. The proposed development activities shaped by past and ongoing work will allow investigators to advance knowledge of depression among medically ill patients by using new concepts, measurement and statistical tools and by creating information systems integrated at the patient level. IP RISP funding would allow us to continue development of important goals that we have pursued since 1995 and represent unique strengths of this application. We have made important progress in the following four areas that are relevant to this application: 1) Integration of mental health research activities into the clinical management and strategic planning activities of HPHC; 2) design of innovative interventions to deliver mental health services to primary care populations at high risk of depression; 3) development of applications of new statistical theory for outcomes assessment and quality measurement; 4) access to a large clinical population in a network model of care enabling us to conduct research in real-world settings. The goal of infrastructure building will be accomplished through the following specific activities. 1. We will develop an information technology enabled disease management system for depression (ITEMSD) occurring in medically ill patients in primary care settings that will include a system for reporting and alerting disease managers about potential gaps in care; a disease manager guideline and documentation system that suggests actions to be pursued; a system for the disease manager to communicate patient assessments, alerts and actions taken to other staff and providers. Consumer preferences will be incorporated into the design of ITEMS-D through use of standard qualitative methods. 2. The team will train disease managers in the principles of Social Learning Theory (SLT) that serves as the theoretical foundation of ITEMS-D, particularly its self-efficacy construct. 3. The research team will work with the HPHC Chief Information Officer and the technology vendor, Perot Systems to design the ITEMS-D database so that it will be easily integrated into all of HPHC's patient-level information systems facilitating rapid access to patient data. 4. Infrastructure development will be used to leverage ITEMS-D to conduct pilot studies related to infrastructure development and the development of RO1, R21 and other grant applications. The experience and talents of the research team working in partnership with HPHC's clinical leadership will allow us to continue building capacity to develop depression intervention research in medically ill populations. We expect that development of ITEMS-D would address the needs of health care delivery systems and serve as the platform for launching future interventions beginning with medically ill populations but extending to other high-risk groups at high risk for depression and other common mental disorders.