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Developing A Collaborative Care Strategy for Depression and Co-Morbid CHF

制定针对抑郁症和共病 CHF 的协作护理策略

基本信息

批准号：
7418923
负责人：
BRUCE Lawrence ROLLMAN
金额：
$ 22.08万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-05-10 至 2010-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7418923
关键词：
Academic Medical Centers Acute Address Adherence Adopted Affect American Anxiety Disorders Area Attention Cardiac Cardiovascular Diseases Cardiovascular system Care given by nurses Caring Case Manager Cessation of life Chronic Disease Class Clinical Clinical Data Clinical Research Clinical Trials Cohort Studies Condition Congestive Congestive Heart Failure Coronary Artery Bypass Data Depressed mood Development Diagnosis Disease Management Effectiveness Enrollment Evidence based treatment Facilities and Administrative Costs Failure Funding Gender Guidelines Health Health Care Costs Health Planning Organizations Healthcare Heart Heart failure Hospitalization Hospitals Individual Inpatients Intervention Left Managed Care Manuals Medical Medical center Mental Depression Morbidity - disease rate National Institute of Mental Health New York Newly Diagnosed Numbers Nurses Operative Surgical Procedures Outcome Outpatients Patient Self-Report Patients Pattern Phase Physicians Primary Health Care Process Measure Protocols documentation Provider Psyche structure Quality of Care Race Range Rate Reporting Research Personnel Resolution Resources Risk Score Screening procedure Services Severities Severity of illness Supervision Telephone Testing Training Treatment Protocols Universities Update Ventricular Work base clinically significant cohort collaborative care compare effectiveness depressive symptoms effectiveness trial experience follow-up health care service utilization health related quality of life hospital readmission improved interest mortality novel programs response therapy development

项目摘要

DESCRIPTION (provided by applicant): Congestive heart failure (CHF) is a common and growing health problem that affects 5 million Americans, with over 550,000 newly diagnosed cases, 287,000 deaths, and $30 billion in direct and indirect costs yearly. Despite a number of care management programs that are being adopted by private and public payers, CHF patients continue to experience poor outcomes. A potential contributor to these poor outcomes is the presence of depression, present in approximately 20-50% of CHF patients. Similar principles of effective chronic disease management apply to both depression and to CHF. Thus, we suggest that screening CHF patients for depression and then utilizing a single nurse care manager working under a physician's supervision to simultaneously deliver evidence-based treatments for both conditions when present is a novel and potentially more sustainable strategy for improving clinical outcomes than referring depressed CHF patients to separate care providers. Our revised three-year R34 treatment development proposal is responsive to NIMH PAR-06-248, From Intervention Development to Services, as its specific aims are to obtain the necessary feasibility and clinical data required to plan a large-scale R01 trial which will compare the effectiveness of a "blended" depression/CHF care management program with current CHF care management programs in reducing depressive symptoms, improving HRQoL, and various other outcomes of interest. It consists of four coordinated phases: (1) Training; (2) Manual Development; (3) Cohort Study; and (4) Pilot Intervention. We will send nurse-recruiter/care managers from our present NIH-funded trial to treat post-CABG depression for training in two local in-patient and out-patient CHF care management programs. We subsequently will integrate the stepped collaborative care protocols for treating depression we developed in our earlier work with guideline-based protocols for treating CHF. Next, we will conduct a cohort study to estimate recruitment and "usual care" treatment patterns for 372 depressed and 100 non-depressed CHF patients. ROC analyses will be applied so as to estimate suitably sensitive and specific PHQ-9 cut-off scores for identifying depressed patients who are likely to die or become rehospitalized at 6-month follow-up. Finally, we will pilot our telephone-based "blended" collaborative care strategy to 30 depressed CHF patients to further refine our treatment strategy.

描述（由申请人提供）：充血性心力衰竭（CHF）是一种常见且日益严重的健康问题，影响了500万美国人，每年有超过55万新诊断病例，287,000例死亡，直接和间接费用达300亿美元。尽管私人和公共支付方正在采用一些护理管理方案，但瑞士法郎患者的预后仍然很差。造成这些不良结果的一个潜在因素是抑郁症的存在，大约20-50%的CHF患者存在抑郁症。