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

制定针对抑郁症和共病 CHF 的协作护理策略

• 批准号: 7615731
• 负责人: BRUCE Lawrence ROLLMAN
• 金额: $ 15.64万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-05-10 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7615731
• 关键词: Academic Medical Centers; Acute; Address; Adherence; Adopted; Affect; American; Anxiety Disorders; Area; Attention; Cardiac; Cardiovascular Diseases; Cardiovascular system; Care given by nurses; Caring; Case Manager; Cessation of life; Chronic Disease; Clinical; Clinical Data; Clinical Research; Clinical Trials; Cohort Studies; Congestive Heart Failure; Coronary Artery Bypass; Data; Development; Diagnosis; Disease Management; Effectiveness; Enrollment; Evidence based treatment; Facilities and Administrative Costs; Failure; Funding; Gender; Guidelines; Health; Health Care Costs; Health Planning Organizations; Healthcare; Heart; Hospitalization; Hospitals; Individual; Inpatients; Intervention; Left; Managed Care; Manuals; Medical; Medical center; Morbidity - disease rate; National Institute of Mental Health; New York; Newly Diagnosed; Nurses; Operative Surgical Procedures; Outcome; Outpatients; Patient Self-Report; Patients; Pattern; Phase; Physicians; Process Measure; Protocols documentation; Provider; Psyche structure; Quality of Care; Race; Reporting; Research Personnel; Resolution; Resources; Risk; Screening procedure; Services; Severities; Severity of illness; Supervision; Telephone; Testing; Training; Treatment Protocols; Universities; Update; Ventricular; Work; base; clinically significant; cohort; collaborative care; compare effectiveness; depressed; depression; depressive symptoms; effectiveness trial; evidence base; experience; follow-up; health care service utilization; health related quality of life; hospital readmission; improved; interest; mortality; novel; physical conditioning; primary care setting; programs; response; routine practice; therapy development; treatment as usual; treatment strategy

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.

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。

项目成果

A positive 2-item Patient Health Questionnaire depression screen among hospitalized heart failure patients is associated with elevated 12-month mortality.

住院心力衰竭患者的 2 项患者健康问卷抑郁筛查呈阳性与 12 个月死亡率升高相关。

• DOI: 10.1016/j.cardfail.2011.11.002
• 发表时间: 2012
• 期刊: Journal of cardiac failure
• 影响因子: 6
• 作者: Rollman,BruceL;HerbeckBelnap,Bea;Mazumdar,Sati;Houck,PatriciaR;He,Fanyin;Alvarez,ReneJ;Schulberg,HerbertC;Reynolds3rd,CharlesF;McNamara,DennisM
• 通讯作者: McNamara,DennisM