Cost of an Evidence Based Depression Care Management Intervention in Home Health

描述（由申请人提供）：尽管在家庭保健中有抑郁症的负担，但很少有家庭保健患者接受符合指南的抑郁症治疗。缺乏经济激励是在包括家庭保健在内的一般医疗环境中实施循证抑郁症治疗模式的主要障碍。nimh资助的“家庭护理抑郁症护理路径”（CAREPATH）随机对照试验将测试针对家庭健康环境与常规护理量身定制的基于证据的抑郁症护理管理干预的有效性。本研究的目的是了解家庭健康机构（HHAs）采用CAREPATH干预的经济诱因。具体目的是：1)评估向临床抑郁的家庭健康患者提供CAREPATH干预对hha的增量成本，包括CAREPATH培训成本、护理人员投入CAREPATH干预的时间成本，以及干预导致的家庭健康访问次数和类型的变化（如果有的话）对成本的影响；2)估计在现行医疗保险家庭健康预期支付系统（PPS）下与CAREPATH干预相关的增量支付，并将这些支付与干预成本进行比较。该项目的数据将来自由CAREPATH研究收集的家庭健康管理数据库，以及研究护士在CAREPATH活动上花费时间的自我报告。我们将利用CAREPATH研究的随机对照设计来估计在家庭健康支付事件水平上与CAREPATH干预相关的增量就诊成本和增量付款，同时考虑到数据的多层次性质（事件、患者、护士和护士团队）。如果发现CAREPATH干预措施有效，研究结果将为hha决定采用该干预措施提供信息，从而解决在常规医疗实践中实施循证抑郁症护理的一个突出障碍。研究结果还将为医疗保险支付的设计提供信息，以鼓励在家庭保健中提供有效的抑郁症治疗。

DESCRIPTION (provided by applicant): Despite the burden of depression in home health care, very few home health patients receive guideline-concordant depression treatment. Lack of economic incentives constitutes a major barrier to the implementation of evidence-based depression treatment models in general medical settings including home health care. The NIMH-funded "Homecare Depression Care path" (CAREPATH) randomized controlled trial will test the effectiveness of an evidence- based depression care management intervention tailored to the home health setting versus usual care. The goal of this proposed research is to understand the economic incentives for adopting the CAREPATH intervention by home health agencies (HHAs). The specific aims are: 1) to assess the incremental cost to HHAs of delivering the CAREPATH intervention to clinically depressed home health patients, including CAREPATH training cost, cost of nurse time devoted to CAREPATH intervention and the cost impact of changes, if any, in the number and types of home health visits as a result of the intervention; and 2) to estimate incremental payments associated with the CAREPATH intervention under the current Medicare home health prospective payment system (PPS) and compare these payments to the cost of the intervention. Data for this project will come from linked home health administrative databases assembled by the CAREPATH study and study nurse self-reports of time spent on CAREPATH activities. We will leverage the randomized controlled design of the CAREPATH study to estimate incremental visit costs and incremental payment associated with the CAREPATH intervention at the level of home health payment episode, taking into account the multi-level nature of the data (episodes, patients, nurses and nurse teams). Results of the study will inform the decisions of HHAs in adopting the CAREPATH intervention if it is found to be effective, thus addressing a prominent barrier to the implementation of evidence-based depression care in routine medical practices. Findings will also inform the design of Medicare payments that can encourage the provision of effective depression treatment in home health care. PUBLIC HEALTH RELEVANCE: Depression among older home health care patients is prevalent and costly, but seriously under- recognized and undertreated. The proposed study will estimate, from the perspective of home health agencies (HHAs), the incremental costs and payments associated with a depression care management intervention currently being tested in home health care. Findings of this project will inform the decision of HHAs in providing evidence-based depression care and the design of Medicare payments that can encourage the provision of effective depression treatment in home health.