An Information tecHnology approach to implEmenting depression treAtment in caRdiac patienTs: [iHeart Trial]

对心脏病患者实施抑郁症治疗的信息技术方法：[iHeart 试验]

• 批准号: 9902517
• 负责人: Nathalie Moise
• 金额: $ 76.11万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9902517
• 关键词: Ambulatory Care; American Heart Association; Antidepressive Agents; Back; Behavioral; Cardiac; Cardiovascular Diseases; Caring; Clinic; Clinical Trials; Communication; Coronary heart disease; Counseling; Data; Depressed mood; Depression screen; Diagnosis; Disease; Disease remission; Effectiveness; Electronic Health Record; Enrollment; Event; Failure; Feedback; Focus Groups; General Population; Goals; Guidelines; Healthcare Systems; Hospitals; Human Resources; Information Technology; International; Intervention; Mental Depression; Motivation; New York; Outcome; Outpatients; Patient Preferences; Patients; Physicians; Population; Presbyterian Church; Prevalence; Primary Health Care; Process; Provider; Public Health; Quality of life; Randomized Controlled Trials; Recommendation; Recurrence; Reporting; Research; Risk; Site; Surveys; Survivors; Symptoms; System; Testing; Time; Visit; Work; acute coronary syndrome; care providers; clinically significant; collaborative care; comorbidity; coping; cost; data format; depressive symptoms; design; effectiveness testing; implementation science; implementation strategy; improved; innovative technologies; mortality; mortality risk; multi-component intervention; primary care setting; primary outcome; programs; screening; screening guidelines; secondary outcome; shared decision making; social stigma; systematic review; theories; tool; treatment adherence; treatment guidelines; uptake

The goal of this proposal is to test whether a theory-informed multicomponent intervention involving an electronic shared decision making (eSDM) tool (iHeart Trial) can increase the uptake of depression treatment following acute coronary syndromes (post-ACS). Depression is three times more common in depressed post- ACS patients than the general population and doubles the risk of recurrent cardiac events and mortality. Depression treatment can improve debilitating depressive symptoms and quality of life. Multiple scientific groups recommend screening for depression and treating when indicated in post-ACS patients. Despite decades of observational data and expert guidelines, only 30% of depressed post-ACS patients receive treatment, far lower than the treatment rates seen in the general depression population. This proposal is a culmination of years of work with multiple study sites, innumerable patients, IT personnel and experts in depression and cardiovascular disease. We reviewed systematically all interventions targeting depression treatment engagement in primary care settings. We conducted a nationwide survey of 352 depressed post-ACS patients. We ran behavioral and primary care provider focus groups to ascertain barriers to depression treatment in primary care in 8 healthcare systems that had implemented depression screening and treatment. We learned that key barriers to depression treatment are (1) suboptimal rates of depression recognition and referral by providers and (2) dismissal of the importance of depressive symptoms and lack of ability to choose type of depression treatment by patients. Using these formative data, we applied a theory- informed process of engaging stakeholders to select an acceptable, feasible intervention and determined that eSDM would target the greatest number of barriers to implementing patient preferred depression treatment in post-ACS patients. We subsequently developed and alpha tested an iPad delivered, video-assisted, interactive eSDM tool that aims to reduce barriers to depression treatment in cardiac patients. We hypothesize that this state-of-the-art, theory-driven eSDM tool that automates the SDM process, activates providers, staff, and patients and interfaces with the electronic health record will improve implementation of depression guidelines in post-ACS patients with persistently elevated depressive symptoms. We propose to conduct a stepped wedge trial across 8 primary care clinics to assess the effectiveness of our eSDM tool on depressive symptoms (primary outcome) and depression treatment uptake (Aim 1) and implementation processes such as depression screening and treatment referral (Aim 2). Key outcomes will be rigorously assessed amongst 368 depressed post-ACS patients. Our study has the potential to produce a theory-informed, scalable eSDM tool that improves the implementation of post-ACS depression guidelines.

这项提案的目标是测试理论知情的多组件干预是否涉及 电子共享决策(ESDM)工具(IHeart Trial)可以增加抑郁症治疗的接受度 急性冠脉综合征(急性冠脉综合征后)。抑郁在抑郁后的患者中的发生率是后者的三倍 与普通人群相比，急性冠脉综合征患者的死亡率增加了一倍，复发心脏事件和死亡率的风险增加了一倍。 抑郁症治疗可以改善衰弱的抑郁症状和生活质量。多元科学 研究小组建议对急性冠脉综合征患者进行抑郁筛查，并在有症状时进行治疗。尽管 几十年的观察数据和专家指南显示，只有30%的急性冠脉综合征后抑郁患者 治疗，远远低于一般抑郁症人群中的治疗率。 这项建议是多年来与多个研究地点、无数患者、IT人员共同努力的结果 以及抑郁症和心血管疾病方面的专家。我们系统地审查了所有针对 初级保健环境中的抑郁症治疗参与度。我们在全国范围内进行了一项352人的调查 急性冠脉综合征后抑郁的患者。我们运行了行为和初级保健提供者焦点小组，以确定障碍 在8个实施了抑郁症筛查的医疗系统中，在初级保健中进行抑郁症治疗 和治疗。我们了解到，抑郁症治疗的主要障碍是(1)抑郁症的发生率不佳 提供者的认可和转介；以及(2)对抑郁症状的重要性不屑一顾 患者选择抑郁症治疗类型的能力。利用这些形成的数据，我们应用了一个理论-- 让利益相关者参与选择可接受的、可行的干预措施的知情过程，并确定 ESDM将针对最大数量的障碍来实施患者偏好的抑郁症治疗 急性冠脉综合征后患者。我们随后开发并阿尔法测试了一款iPad，提供视频辅助， 旨在减少心脏病患者抑郁治疗障碍的交互式ESDM工具。 我们假设，这种先进的、理论驱动的ESDM工具可以自动执行SDM流程， 激活提供者、工作人员和患者，与电子健康记录的接口将得到改进 急性冠脉综合征后抑郁症状持续升高患者的抑郁指南的实施。 我们建议在8家基层医疗诊所进行阶梯式楔形试验，以评估我们的 关于抑郁症状(主要结果)和抑郁治疗吸收的ESDM工具(目标1)和 实施抑郁症筛查和治疗转介等进程(目标2)。主要成果将是 在368名急性冠脉综合征后抑郁患者中进行了严格的评估。我们的研究有可能产生一种 理论知情、可扩展的ESDM工具，可改进ACS后抑郁指南的实施。