Reducing Hospital Readmission Among Medical Patients with Depressive Symptoms

减少有抑郁症状的内科患者再入院率

• 批准号: 8235619
• 负责人: BRIAN William JACK
• 金额: $ 49.25万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8235619
• 关键词: Reducing; Hospital; Readmission; Among; Medical

DESCRIPTION (provided by applicant): Depressive symptoms in medical patients are associated with increased healthcare utilization, including post-discharge readmissions at rates 73% higher than that of their non-depressed counterparts. In prior work, we showed that a ReEngineered Discharge (RED) that standardized discharge processes improved readmission rates in patients with depressive symptoms, but they remained significantly higher than those without depression. In this project we evaluate the impact of adding Collaborative Care for depression to RED in an attempt to lower readmission rates for those patients with depressive symptoms. Design: Two-arm Randomized Controlled Trial Hypotheses: The combination of Collaborative Care for depression and the RED program will (1) decrease 30 and 90 day readmission rates and (2) improve mental health related quality of life more than patients receiving RED alone. Population Studied: Patients admitted to a general medical service at an urban safety net hospital. The subjects studied represent low-income, ethnically diverse urban populations, who have all screened positive for depression. This study meets AHRQ guidelines for the inclusion of priority populations in research. The intervention is designed to be used while subjects are inpatient and then for 12 weeks post-discharge as an outpatient. Methods: After adapting and testing the intervention, 1052 patients over 18 years old, admitted to the general medical service of Boston Medical Center with at least a moderate level of depressive symptoms (Patient Health Questionnaire score e10) will be enrolled and randomized into one of 2 groups (1) 526 receiving our "Re-engineered Hospital Discharge" intervention, a set of 11 discrete, mutually reinforcing components provided by a care manager and re-enforced by a telephone call 2-4 days after discharge by a clinical pharmacist (RED), and (2) 526 receiving the RED plus 12 weeks of collaborative care for depression including a care manager to deliver via weekly telephone calls a set of interventions in conjunction with patients' primary care physician and personal preferences: depression self-management program, psychopharmacology, and referral to mental health professionals (RED-D). Outcome Measures: The primary patient centered outcomes are the 30 and 90 day subsequent hospital readmission. Secondary outcomes include (1) mental health status as measured by the SF-36 and (2) cost analysis. Expected Results: This project will provide valuable information about whether including collaborative care for depression in a standardized discharge process will improve readmission rates. PUBLIC HEALTH RELEVANCE: Hospital readmission is now a major focus of national health care policy. One out of every 10 hospital stays included a diagnosis of mood disorders (over 3.3 million stays) and these patients are much more likely to be readmitted to the hospital. In an attempt to lower the rehospitalizaton rates of patients with depressive symptoms, this project will augment the ReEngineered Discharge (RED) -- an evidence-based process to prepare patients for discharge -- with a care treatment program for depression using a care manager in collaboration with primary care physicians to deliver self-management education, antidepressant medication and referral to mental health professionals.

描述（由申请人提供）：医学患者的抑郁症状与医疗保健利用率的增加有关，包括以比其非抑郁症的同类培养物高73％的送礼后再入院。在先前的工作中，我们证明了重新设计的排放（红色），标准化的排放过程提高了抑郁症状的患者的再入院率，但它们仍然明显高于没有抑郁症的患者。在这个项目中，我们评估了将抑郁症的协作护理增加为红色的影响，以降低那些患有抑郁症状的患者的再入院率。设计：两臂随机对照试验假设：抑郁症的协作护理和红色计划的结合将（1）降低30和90天的再入院率，以及（2）比单独接受红色的患者改善与心理健康相关的生活质量。人口研究：在城市安全网医院接受一家普通医疗服务的患者。所研究的受试者代表了低收入，种族多样化的城市人口，他们对抑郁症的筛查都呈阳性。这项研究符合AHRQ指南，以将优先人群纳入研究。该干预措施被设计为在受试者住院时使用，然后在入院后12周作为门诊。 Methods: After adapting and testing the intervention, 1052 patients over 18 years old, admitted to the general medical service of Boston Medical Center with at least a moderate level of depressive symptoms (Patient Health Questionnaire score e10) will be enrolled and randomized into one of 2 groups (1) 526 receiving our "Re-engineered Hospital Discharge" intervention, a set of 11 discrete, mutually reinforcing components provided by a care manager and由临床药剂师（红色）出院后2-4天通过电话加强，（2）526接受红色加上12周的抑郁症协作护理12周的协作护理，包括一名每周通过每周电话的护理经理，与患者的初级保健医师和个人偏爱的一系列干预措施交付，与抑郁症的自我管理计划：抑郁症自我管理计划：心理学疗程，心理素养和推荐的心理健康和参考健康（Red-Dressive of Coradesalts and Corseversals of Corseversition and Red）。结果指标：主要患者的结果是随后的30天和90天的医院再入院。次要结果包括（1）通过SF-36和（2）成本分析衡量的心理健康状况。预期结果：该项目将提供有关是否在标准化流程中包括抑郁症的协作护理是否会提高再入院率的宝贵信息。 公共卫生相关性：医院再入院现在是国家卫生保健政策的重点。每10个医院中的一分之一包括诊断情绪障碍（超过330万次），这些患者更有可能被送往医院。为了降低患有抑郁症状的患者的重新住宿性降低率，该项目将增加重新设计的出院（RED）（RED）（RED），这是一种基于证据的过程，以准备出院的病人 - 使用抑郁症的护理治疗计划使用护理人员与初级保健医生合作提供自我管理，以提供自我管理的教育，抗抑郁药，抗抑郁药，并向精神卫生专业人员提及。