Developing A Collaborative Care Strategy for Depression and Co-Morbid CHF

描述（由申请人提供）：充血性心力衰竭（CHF）是一种常见且日益严重的健康问题，影响了500万美国人，每年有超过55万新诊断病例，287,000例死亡，直接和间接费用达300亿美元。尽管私人和公共支付方正在采用一些护理管理方案，但瑞士法郎患者的预后仍然很差。造成这些不良结果的一个潜在因素是抑郁症的存在，大约20-50%的CHF患者存在抑郁症。

DESCRIPTION (provided by applicant): Congestive heart failure (CHF) is a common and growing health problem that affects 5 million Americans, with over 550,000 newly diagnosed cases, 287,000 deaths, and $30 billion in direct and indirect costs yearly. Despite a number of care management programs that are being adopted by private and public payers, CHF patients continue to experience poor outcomes. A potential contributor to these poor outcomes is the presence of depression, present in approximately 20-50% of CHF patients. Similar principles of effective chronic disease management apply to both depression and to CHF. Thus, we suggest that screening CHF patients for depression and then utilizing a single nurse care manager working under a physician's supervision to simultaneously deliver evidence-based treatments for both conditions when present is a novel and potentially more sustainable strategy for improving clinical outcomes than referring depressed CHF patients to separate care providers. Our revised three-year R34 treatment development proposal is responsive to NIMH PAR-06-248, From Intervention Development to Services, as its specific aims are to obtain the necessary feasibility and clinical data required to plan a large-scale R01 trial which will compare the effectiveness of a "blended" depression/CHF care management program with current CHF care management programs in reducing depressive symptoms, improving HRQoL, and various other outcomes of interest. It consists of four coordinated phases: (1) Training; (2) Manual Development; (3) Cohort Study; and (4) Pilot Intervention. We will send nurse-recruiter/care managers from our present NIH-funded trial to treat post-CABG depression for training in two local in-patient and out-patient CHF care management programs. We subsequently will integrate the stepped collaborative care protocols for treating depression we developed in our earlier work with guideline-based protocols for treating CHF. Next, we will conduct a cohort study to estimate recruitment and "usual care" treatment patterns for 372 depressed and 100 non-depressed CHF patients. ROC analyses will be applied so as to estimate suitably sensitive and specific PHQ-9 cut-off scores for identifying depressed patients who are likely to die or become rehospitalized at 6-month follow-up. Finally, we will pilot our telephone-based "blended" collaborative care strategy to 30 depressed CHF patients to further refine our treatment strategy.