A System for Management of Depression in Medical Illness

本干预和实践研究基础设施支持计划（IP-RISP）申请寻求资金支持概念，方法和组织发展，以促进慢性疾病初级保健患者的抑郁症干预研究。过去和正在进行的工作所形成的拟议发展活动将使研究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层面集成的信息系统来提高对医学疾病患者中抑郁症的认识。IP RISP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，并代表该应用程序的独特优势。我们在以下四个与此应用相关的领域取得了重要进展：1）将心理健康研究活动纳入HPHC的临床管理和战略规划活动; 2）设计创新干预措施，为抑郁症高危人群提供初级保健服务; 3）发展新的统计理论在结果评估和质量测量中的应用; 4）在护理网络模型中访问大量临床人群，使我们能够在现实世界中进行研究。基础设施建设的目标将通过以下具体活动来实现。 1.我们将开发一个信息技术支持的抑郁症疾病管理系统（ITEMSD），用于治疗初级保健环境中的内科病人，其中包括一个报告和提醒疾病管理人员注意护理方面潜在差距的系统;一个疾病管理人员指南和文件系统，建议采取行动;疾病管理人员将患者评估、警报和采取的行动传达给其他工作人员和提供者的系统。将通过使用标准的定性方法，将消费者的偏好纳入项目D的设计。 2.该团队将在社会学习理论（Social Learning Theory）的原则中培训疾病管理人员，该理论是ITEMS-D的理论基础，特别是其自我效能感。 3.研究团队将与HPHC首席信息官和技术供应商Perot Systems合作，设计ITEMS-D数据库，以便轻松集成到HPHC的所有患者级信息系统中，从而促进快速访问患者数据。 4.基础设施发展将用于利用ITEMS-D进行与基础设施发展和开发RO 1、R21和其他赠款申请有关的试点研究。与HPHC临床领导层合作的研究团队的经验和才能将使我们能够继续建立在医学患病人群中开展抑郁症干预研究的能力。我们期望ITEMS-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，从医学患病人群开始，但扩展到抑郁症和其他常见精神障碍的高风险人群。

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.