Effect of Chronic Illness Complexity on Evidence-Based Depression Treatment

描述（由申请人提供）：疾病通常是在与其他疾病状态隔离的情况下描述和研究的，然而许多个体有多种慢性疾病同时发生（MCC）。MCC被定义为至少有三种慢性疾病，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患者最常见的合并症之一。大多数抑郁症患者最初在初级保健（PC）治疗，抑郁症的协作护理模式已被证明可以改善在初级保健中治疗的抑郁症患者的护理过程和结果。抑郁症管理模式对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伴有两种或两种以上合并症的抑郁症患者的影响。我们建议制定一个方案，以帮助优先考虑哪些抑郁症患者最需要抑郁症护理管理，并帮助确定抑郁症- mcc集群，这些集群可能是开发多种疾病管理计划的合适候选人。

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.