Depression-Diabetes Care Disparities, Adverse Outcomes

描述（由申请人提供）：我们的目标是为糖尿病、抑郁症以及相关的临床和行为风险因素的综合管理建立流行病学基础。患有糖尿病抑郁症合并症的人更有可能患有糖尿病并发症，临床控制较差，行为危险因素增加，残疾增加。这项研究将为200万患有糖尿病和抑郁症的美国人提供一个综合的生物心理社会方法的经验基础。这项研究将建立在一项对4839名糖尿病患者的完整调查的基础上，该调查评估了糖尿病护理、抑郁、残疾以及糖尿病和心脏病的相关风险因素。我们将对所有幸存者进行为期5年的随访调查，以评估抑郁和残疾的结果，以及患者护理的优先事项。我们将使用GHC和华盛顿州的死亡记录来衡量死亡率。使用GHC医疗记录在5年随访期内监测血糖、血压和血脂控制、糖尿病并发症和医疗保健质量。研究目标将通过实现三个目标来实现：目标1：评估不良结局的预测因素-我们将开发不良结局发生率的风险预测模型，包括：5年全因死亡率、冠状动脉疾病（CAD）和脑血管疾病（CVA）死亡率、微血管和大血管并发症事件、临床控制不良（血糖、血压和血脂控制）、日常生活活动恶化和重度抑郁症。一个主要的焦点将是抑郁症对糖尿病不良后果的贡献。目标2：确定抑郁症与非抑郁症糖尿病患者的医疗保健差异。我们将评估抑郁症-糖尿病共病是否与以下医疗保健质量差异相关：临床控制（血糖、血压和血脂控制）;预防性筛查和治疗;以及行为风险因素降低（肥胖、久坐生活方式和戒烟干预）。目标3：确定综合服务的优先事项-我们将评估与糖尿病、抑郁症和相关行为风险因素综合管理优先事项相关的标准。

DESCRIPTION (provided by applicant): Our goal is to develop an epidemiological basis for integrated management of diabetes, depressive illness, and associated clinical and behavioral risk factors. Persons with diabetes depression co-morbidity are more likely to have diabetes complications, poorer clinical control, increased behavioral risk factors, and increased disability. The proposed research will provide an empirical basis for an integrated, biopsychosocial approach for care of the two million Americans afflicted by diabetes and major depression. This research will build on a completed survey of 4839 persons with diabetes in Group Health Cooperative (GHC) that assessed diabetes care, depression, disability, and associated risk factors for diabetes and heart disease. We will carry out a 5-year follow-up survey with all survivors to assess depression and disability outcomes, and patient priorities for their care. We will use GHC and Washington State death records to measure mortality. Glycemic, blood pressure, and lipid control, diabetic complications, and quality of health care will be monitored over the five-year follow-up period using GHC medical records. The research goal will be achieved by accomplishing three aims: Aim 1: Assess predictors of adverse outcomes - We will develop risk-prediction models for the incidence of adverse outcomes including: 5-year all-cause mortality, coronary disease (CAD) and cerebrovascular (CVA) mortality, incident microvascular and macrovascular complications, poor clinical control (glycemic, blood pressure and lipid control), deterioration in activities of daily living and major depression. A major focus will be the contribution of depression to adverse diabetes outcomes. Aim 2: Identify disparities in health care for depressed vs. non-depressed persons with diabetes. We will assess whether depression-diabetes co-morbidity is associated with disparities in the quality of health care for: clinical control (glycemic, blood pressure and lipid control); preventive screening and treatment; and for behavioral risk factor reduction (interventions for obesity, sedentary lifestyle, and smoking cessation). Aim 3: Set priorities for integrated services - We will assess criteria relevant to priorities for integrated management of diabetes, depression and associated behavioral risk factors.