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

描述(申请人提供)：尽管家庭健康护理中有抑郁症的负担，但很少有家庭健康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以证据为基础的抑郁症治疗模式的主要障碍。NIMH资助的“家庭护理抑郁护理路径”(CAREPATH)随机对照试验将测试针对家庭健康环境和常规护理而量身定做的循证抑郁症护理管理干预的有效性。这项拟议研究的目标是了解家庭卫生机构(HHA)采用CAREPATH干预的经济动机。具体目标是：1)评估向临床抑郁症家庭健康患者提供CAREPATH干预措施对医管局的增量成本，包括CAREPATH培训成本、用于CAREPATH干预的护士时间成本以及干预措施导致的家庭健康就诊次数和类型的变化(如果有)对成本的影响；以及2)估计在当前Medicare家庭健康预期支付系统(PPS)下与CAREPATH干预措施相关的增量付款，并将这些付款与干预的成本进行比较。这个项目的数据将来自CAREPATH研究和研究护士在CAREPATH活动上花费的时间的自我报告收集的链接的家庭健康管理数据库。我们将利用CAREPATH研究的随机对照设计，在家庭健康支付事件的水平上估计与CAREPATH干预相关的增量访问成本和增量支付，同时考虑到数据(事件、患者、护士和护士团队)的多层次性质。这项研究的结果将告知卫生署决定采用CAREPATH干预措施是否有效，从而消除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参考，以鼓励在家庭医疗保健中提供有效的抑郁症治疗。 公共卫生相关性：老年家庭保健患者中的抑郁症很普遍，成本也很高，但严重得不到认识和治疗。这项拟议的研究将从家庭健康机构(HHA)的角度估计与目前在家庭健康护理中测试的抑郁症护理管理干预相关的增量成本和支付。这一项目的结果将为卫生署在提供基于证据的抑郁症护理方面的决定和医疗保险付款的设计提供信息，以鼓励在家庭健康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.