Improving CLTC System Response to Late Life Depression

描述(由申请人提供)：为响应NIMH PAR-03-078《从干预发展到服务：探索性研究资助》(R34)，我们寻求支持，以开发一种系统层面的干预措施，以改善接受公共资助的社区长期护理(CLTC)服务的抑郁症老年人的护理。我们的目标是开发一种可以接受并可持续在公共CLTC中进行的系统改进。我们将利用已发表的研究(全球知识)和通过我们8年的临床流行病学和服务系统研究积累的护理系统的本地知识，采用阶段性干预发展模式。具体目标是(1)整合全球知识(来自已发表的研究)和当地知识(从CLTC系统以前的工作中获得)，涉及(A)抑郁症的患病率、病程和合并症；(B)利益相关者对抑郁症治疗的偏好，以及(C)CLTC应对抑郁症的资源，以得出干预的影响；(2)聘请专家小组利用这些知识具体说明干预措施，“评估、链接和支持”，以改善CLTC中的抑郁症护理；(3)编写治疗和培训手册；(4)开发客户和系统结果的跟踪方法；以及(5)评估干预的可行性、可接受性和适当性，并为后续的有效性研究收集初步数据。质量改进和组织复杂性理论为干预发展模型提供了理论基础。利用行为聚合方法，我们将召集一个由当地和国家专家组成的多学科小组，审查拟议的干预措施、基于竞争需求理论的具体成分、网关过滤器链接模型以及动机增强-变革准备。这一干预发展努力响应了总统关于精神健康的新自由委员会报告(2003年)的建议，即在公共卫生和公共服务中建立精神健康筛查和早期干预方案。通过CLTC改善抑郁症护理可以将心理健康治疗扩展到社会和经济上处于不利地位的老年人，这些老年人历史上没有得到充分利用的专门心理健康护理。我们将通过一项R01研究来跟踪这项工作，以严格测试干预的有效性。

DESCRIPTION (provided by applicant): In response to NIMH PAR-03-078, "From intervention development to services: Exploratory Research Grants" (R34), we seek support to develop a system-level intervention for improving care for depressed older adults who receive publicly funded community long-term care (CLTC) services. Our goal is to develop a system improvement that is acceptable to and can be sustained in public CLTC. We will employ a staged model for intervention development drawing on both published research (global knowledge) and local knowledge of the system of care accrued through our 8 years of clinical epidemiological and service systems research. Specific Aims are to (1) Consolidate global knowledge (from published studies) and local knowledge (gained from prior work in the CLTC system) about (a) depression prevalence, course, and comorbidities; (b) stakeholder preferences for depression treatment, and (c) CLTC resources for responding to depression for purposes of deriving implications for intervention; (2) Engage an expert panel to use this knowledge to specify an intervention, "Assess, Link, and Support," to improve depression care in CLTC; (3) Develop treatment and training manuals; (4) Develop tracking methods for client and system outcomes; and (5) Assess the feasibility, acceptability, and appropriateness of the intervention and collect preliminary data for a subsequent effectiveness study. Quality improvement and organizational complexity theories inform the model of intervention development. Employing behavior aggregation methods, we will convene a multidisciplinary panel of local and national experts to vet a proposed intervention, specific ingredients which are based on theories of competing demands, the gateway filter linkage model, and motivational enhancement-readiness to change. This intervention development effort is responsive to recommendations of the President's New Freedom Commission Report on Mental Health (2003) to institute mental health screening and early intervention programs in public health and human services. Improving depression care through CLTC can extend mental health treatment to socially and economically disadvantaged elders, who historically have underutilized specialty mental health care. We will follow this work by an R01 study to test the intervention's effectiveness rigorously.