Effect of Chronic Illness Complexity on Evidence-Based Depression Treatment

描述(由申请人提供)：疾病的描述和研究通常是在孤立的其他疾病状态下进行的，然而许多人有多种慢性疾病同时发生(MCC)。MCC被定义为至少有三种慢性病，在美国老年人中非常普遍。MCC患者在住院期间发生可避免的住院和可预防的并发症的风险较高。抑郁症是MCC患者最常见的共生疾病之一。大多数抑郁症患者最初在初级保健(PC)中接受治疗，而抑郁症的协作护理模式已被证明可以改善在PC中治疗的抑郁症患者的护理过程和结果。抑郁症疾病管理模式对MCC患者的价值尚不清楚。没有研究明确考虑抑郁症护理管理对合并2种或更多抑郁症的人的影响。我们建议开发一个方案来帮助确定哪些抑郁症患者最需要抑郁症护理管理的优先顺序，并帮助识别可能适合于开发多条件疾病管理计划的抑郁症-MCC集群。 本研究的目的是通过三个具体目标来检验不同的慢性疾病组(MCC组)对接受循证抑郁症治疗的可能性的影响：(1)比较每个抑郁症-MCC组中接受循证抑郁症治疗的患者的比例；(2)确定接受临床护理的类型(仅PC与共享的精神健康或其他专门护理)在调节抑郁症-MCC与接受循证抑郁症治疗之间的关系的程度；(3)评估患者和系统因素在多大程度上调节或调节抑郁症-MCC与接受循证抑郁症治疗之间的关系。 这项研究将采用回溯性队列设计，并使用退伍军人健康管理局(VA)和联邦医疗保险当前受益人调查的管理数据。将确定患有8种高度流行和/或费用高昂的慢性疾病的老年人，这些疾病通常与抑郁症并存。将使用双变量和多变量方法来确定抑郁症-MCC集群与接受指南一致的抑郁症治疗之间的关系，以及所接受的临床护理类型和其他患者和系统因素在多大程度上调节/调节抑郁症-MCC集群和高质量抑郁症护理之间的关系。

DESCRIPTION (provided by applicant): Diseases are often described and studied in isolation of other disease states, yet many individuals have multiple chronic conditions occurring together (MCC). Defined as having at least three chronic conditions, MCC is highly prevalent among elderly Americans. Persons with MCC have a higher risk for avoidable hospitalizations and preventable complications while hospitalized. Depression is one of the most common co-occurring illnesses in those with MCC. Most patients with depression are initially treated in primary care (PC), and collaborative care models for depression have been shown to improve care processes and outcomes for depression patients treated in PC. The value of depression disease management models for patients with MCC is less clear. No studies have explicitly considered the effect of depression care management for persons with depression plus 2 or more comorbid conditions. We propose to develop a schema to help prioritize which depression patients most need depression care management, and help identify depression-MCC clusters that may be appropriate candidates for the development of multiple condition disease management programs. The objective of this study is to examine, for persons with depression, the effect of various groups of chronic diseases (clusters of MCC) on the likelihood of receipt of evidence-based depression treatment through 3 specific aims: (1) Compare the proportion of patients in each depression-MCC cluster that receive evidence-based depression care; (2) Determine the extent to which type of clinical care received (PC only versus shared mental health or other specialty care) mediates the relationship between depression-MCC and receipt of evidence-based depression treatment; (3) Assess the extent to which patient and system factors mediate or moderate the relationship between depression-MCC and receipt of evidence-based depression treatment. This study will employ a retrospective cohort design and use administrative data from the Veteran Health Administration (VA) and the Medicare Current Beneficiary Survey. Elderly persons with 8 highly prevalent and/or high cost chronic conditions that commonly co-occur with depression will be identified. Bivariate and multivariate methods will be used to determine the relationships between depression-MCC clusters and receipt of guideline-concordant depression treatment as well as the extent to which the type of clinical care received and other patient and system factors mediate/moderate the relationship between depression-MCC cluster and quality depression care.