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

描述(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，影响着500万美国人，每年有超过55万新诊断病例，28.7万人死亡，直接和间接成本为300亿美元。尽管私人和公共支付者正在采用一些护理管理计划，但CHF患者继续经历着糟糕的结果。导致这些不良结果的一个潜在因素是抑郁的存在，大约20%-50%的CHF患者存在抑郁。 有效的慢性病管理原则同样适用于抑郁症和充血性心力衰竭。因此，我们建议筛查CHF患者的抑郁，然后利用一名护士在医生的监督下工作，同时为这两种情况提供循证治疗，这是一种新颖的、潜在的更可持续的改善临床结果的策略，而不是将抑郁的CHF患者转至单独的护理提供者。 我们修订后的为期三年的R34疗法开发方案符合NIMH PAR-06-248《从干预开发到服务》，因为它的具体目标是获得必要的可行性和规划大规模R01试验所需的临床数据，该试验将比较“混合型”抑郁症/CHF护理管理计划与当前CHF护理管理计划在减少抑郁症状、改善HRQOL和其他各种感兴趣的结果方面的有效性。它由四个协调阶段组成：(1)培训；(2)手工开发；(3)队列研究；(4)试点干预。我们将从我们目前由NIH资助的试验中派遣护士招聘人员/护理经理来治疗CABG后抑郁，接受两个当地住院和门诊CHF护理管理项目的培训。随后，我们将把我们在早期工作中开发的治疗抑郁症的阶梯式协作护理方案与基于指南的治疗CHF的方案相结合。接下来，我们将进行一项队列研究，以评估372名抑郁症CHF患者和100名非抑郁症CHF患者的招募和“常规护理”治疗模式。ROC分析将被应用，以估计适当敏感和特定的PHQ-9截止分数，以确定在6个月的随访中可能死亡或再次住院的抑郁症患者。最后，我们将向30名抑郁症充血性心力衰竭患者试行我们的基于电话的“混合式”协作护理策略，以进一步完善我们的治疗策略。

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.