Blended Collaborative Care for Heart Failure and Co-Morbid Depression

心力衰竭和共病抑郁症的混合协作护理

• 批准号: 8437510
• 负责人: BRUCE Lawrence ROLLMAN
• 金额: $ 124.08万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8437510
• 关键词: Adherence; Adopted; Adult; Advocate; Affect; Ambulatory Care; American; Ancillary Study; Back; Cardiac; Cardiovascular Diseases; Cardiovascular system; Caring; Case Manager; Cessation of life; Chronic; Chronic Disease; Clinical; Clinical Research; Complex; Coronary Artery Bypass; Depression screen; Development; Disease; Disease Management; EFRAC; Effectiveness; Elements; Enrollment; Event; Failure; Genomics; Guidelines; Health Care Costs; Health Status; Heart; Heart failure; Hospitalization; Hospitals; Incidence; Inflammation; Intervention; Link; Mediating; Mediator of activation protein; Medical; Medical center; Medicare; Medicine; Mental Depression; Methods; Moods; Morbidity - disease rate; New York; Newly Diagnosed; Operative Surgical Procedures; Outcome; Patients; Pharmacotherapy; Phase; Physical Function; Pilot Projects; Primary Care Physician; Protocols documentation; Public Health; Randomized; Recommendation; Recruitment Activity; Resources; Self Management; Sleep; Supervision; Symptoms; System; Systolic heart failure; Telephone; Testing; Universities; Work; base; blood pressure regulation; cardiovascular risk factor; chronic care model; clinical practice; collaborative care; comparative effectiveness; compare effectiveness; cost; cost effective; cost effectiveness; depressive symptoms; effectiveness trial; evidence base; experience; follow-up; functional status; health care delivery; health care service utilization; health related quality of life; high risk; improved; innovation; medical specialties; mortality; multidisciplinary; novel; physical conditioning; pragmatic trial; programs; public health relevance; routine care; routine practice; treatment as usual; treatment effect; treatment program

DESCRIPTION (provided by applicant): Heart failure (HF) is an important public health problem that affects approximately 6.6 million Americans. Despite improvements in cardiac care, it remains the leading cause for hospitalization among Medicare patients and the only major cardiovascular disease whose mortality rate has remained essentially unchanged over the past decade. This failure to improve HF outcomes may be due, in part, to unrecognized and/or inadequately treated depression that is highly prevalent in HF patients. Yet while new HF treatment guidelines advocate routine screening for depression, this recommendation is unlikely to be widely adopted without trial evidence that depression care improves outcomes and efficient methods to provide it. "Collaborative care" strategies are being increasingly utilized t improve care for HF and other chronic medical conditions, and we recently demonstrated its clinical and cost-effectiveness at treating depression following coronary artery bypass graft surgery. Yet it may be impractical for health care delivery systems to support separate treatment programs for HF and depression. Thus we are encouraged by emerging evidence indicating "blended" collaborative care strategies that target both psychiatric and physical conditions produce greater improvements in mood symptoms and control of cardiovascular risk factors than programs focused solely on depression to propose testing a novel adaptation that could be provided in routine care. The Specific Aims of this Project are to: (1) evaluate the effectiveness of a telephone-delivered "blended" collaborative care intervention for treating HF and depression that could be adopted into routine clinical practice if proven effective; and (2) advance our understanding of the moderators and mediators of depression treatment on clinical outcomes. We will screen hospitalized patients with systolic HF for depression, and then randomize 625 who screen positive and have at least a moderately elevated level of depressive symptoms at two-weeks following hospital discharge to either: (1) collaborative care for treating both HF and depression ("blended"); (2) collaborative care for treating HF alone (enhanced usual care (eUC)); or (3) their doctors' "usual care" (UC). Additionally, we will enroll 125 non-depressed HF patients to better evaluate the benefits derived from treating depression (total N=750). Our co-primary hypotheses will test whether "blended" collaborative care can produce at 12-months follow-up a: (A) 0.50 effect size (ES) or greater improvement in health-related quality of life (HRQoL) vs. UC; and (B) 0.30 ES or greater improvement in HRQoL vs. eUC. Secondary hypotheses will evaluate the effects of our "blended" intervention on mood, functional status, adherence with guideline-consistent care, incidence of cardiovascular events, health care utilization, and costs. Improving chronic illness care for medically complex patients is one of the major challenges facing medicine today. We propose to test the effectiveness of an innovative, efficient, scalable, and sustainable intervention that could transform the way HF and other cardiovascular disorders are treated in routine practice.

描述(由申请者提供)：心力衰竭(HF)是一个重要的公共卫生问题，影响着大约660万美国人。尽管心脏护理有所改善，但它仍然是医疗保险患者住院的主要原因，也是过去十年死亡率基本保持不变的唯一主要心血管疾病。这种未能改善心力衰竭预后的部分原因可能是由于心力衰竭患者中非常普遍的抑郁症未被识别和/或治疗不当。然而，尽管新的心力衰竭治疗指南提倡对抑郁症进行常规筛查，但如果没有试验证据表明抑郁症护理可以改善结果和提供有效的方法，这一建议不太可能被广泛采用。“协作性护理”策略正被越来越多地用于改善对心力衰竭和其他慢性疾病的护理，我们最近展示了其在治疗冠状动脉搭桥术后抑郁方面的临床和成本效益。然而，对于医疗保健提供系统来说，支持心衰和抑郁症的单独治疗计划可能是不切实际的。因此，我们感到鼓舞的是，越来越多的证据表明，与仅关注抑郁症的项目相比，针对精神和身体状况的“混合”合作护理策略在情绪症状和心血管风险因素控制方面产生了更大的改善，这些项目建议测试一种可以在常规护理中提供的新适应。本项目的具体目标是：(1)评估效果 为治疗心力衰竭和抑郁症提供电话传递的“混合”协作护理干预，如果被证明有效，可以应用于常规临床实践；以及(2)增进我们对抑郁症治疗对临床结果的调节和中介的理解。我们将筛查患有收缩心衰的住院患者的抑郁症状，然后将625名筛查呈阳性且在出院后两周内至少有中度升高的抑郁症状的患者随机分为以下两组：(1)同时治疗心力衰竭和抑郁症的协同护理(“混合”)；(2)单独治疗心力衰竭的协同护理(增强型日常护理(EUC))；或(3)他们的医生的“日常护理”(UC)。此外，我们将招募125名非抑郁性心衰患者，以更好地评估治疗抑郁症的益处(总N=750)。我们的共同主要假设将测试“混合式”协作护理是否可以在12个月的随访中产生：(A)0.50效果大小(ES)或与UC相比健康相关的生活质量(HRQOL)有更大改善；以及(B)HRQL相对于EUC有0.30 Es或更大改善。第二个假设将评估我们的“混合式”干预对情绪、功能状态、遵守指南一致性护理、心血管事件发生率、医疗保健利用率和成本的影响。改善对复杂医学患者的慢性病护理是当今医学面临的主要挑战之一。我们建议测试一种创新的、高效的、可扩展的和可持续的干预措施的有效性，这种干预措施可以改变常规做法中治疗心力衰竭和其他心血管疾病的方式。