Effectiveness of a Depression Care Management Initiative in Home Healthcare

描述(申请人提供)：这项研究的目标是改善老年家庭保健患者的抑郁症治疗和结果。家庭护理是越来越多因疾病或残疾而被困在家中的患有疾病或受伤的老年人的主要保健来源。We1和其他2已经证明，与年龄相近的初级保健患者相比，临床上有意义的抑郁症在这一患者群体中的流行程度是两倍。抑郁症可以在老年人中得到有效治疗，治疗指南已经制定，以帮助医生为他们的老年抑郁症患者做出治疗决定。然而，医疗家庭保健患者很少接受与指南一致的抑郁症治疗。这项申请申请资金，以测试干预措施的有效性，“家庭护理抑郁CAREPATH”(CAREPATH)，对两个结果：1.抑郁症治疗(即，开始治疗或改变治疗，符合指南)，和2.抑郁症状(即，随着时间的推移，抑郁症状减少)。CAREPATH协议是与家庭医疗保健提供商合作设计的。它包括抑郁症护理管理模式的主要要素，这些要素已被证明在初级保健中有效，但重新调整这些要素以适应家庭保健患者的临床需求，并与家庭保健实践保持一致。干预措施本身被设计为具有生态敏感性，以最大限度地提高该计划的可行性和普及性。CAREPATH的干预措施将在爱荷华州、密歇根州、纽约市、俄克拉何马州和纽约州北部的五家家庭护理机构内部和之间进行测试。参与的五家家庭保健机构已经表明了对这一研究伙伴关系的承诺，并已经在康奈尔大学的“抑郁评估培训”(Triad)中培训了他们的工作人员。共有100名护士将由预先存在的团队随机分配到CAREPATH或常规护理。CAREPATH对抑郁症治疗的影响将使用所有机构常规收集的数据在所有符合条件的患者(N~1000人)中进行测试，因为这些数据是机构通常用于质量保证的数据类型。抑郁症状的结果将使用汉密尔顿抑郁评定量表(HDRS)进行测试，该量表由研究人员从(N=500)患者中收集，这些患者同意在12周和24周进行面对面的基线和电话随访。如果有效，CAREPATH干预可以降低使用家庭护理的老年人中未解决的抑郁症的发生率。在机构一级，CAREPATH可由参与机构维持，并向全国其他感兴趣的家庭保健机构传播。

DESCRIPTION (provided by applicant): The goal of this research is to improve depression treatment and outcomes among elderly home healthcare patients. Homecare nursing is a major source of health care for a large and growing number of medically ill or injured older adults who are homebound by illness or disability. We1 and others2 have documented that clinically significant depression is twice as prevalent in this patient population compared to similarly aged primary care patients. Depression can be effectively treated in older adults, and treatment guidelines have been developed to help physicians make treatment decisions for their depressed older patients. However, medical home healthcare patients rarely receive guideline-consistent treatment for depression. This application request funds to test the effectiveness of an intervention, "Homecare Depression Carepath" (CAREPATH), on two outcomes: 1. Depression treatment (i.e., initiate treatment or have a change in treatment that is consistent with guidelines), and 2. Depressive symptoms (i.e., reduction in depressive symptoms over time). The CAREPATH protocol was designed in partnership with home healthcare providers. It includes the major elements of depression care management models that have proven effective in primary care but restructures these elements to fit the clinical needs of home healthcare patients and for consistency with home healthcare practice. The intervention itself is designed to be ecologically sensitive to maximize the feasibility and generalizability of the program. The CAREPATH Intervention will be tested within and among five homecare agencies located in Iowa, Michigan, New York City, Oklahoma and Upstate New York. The five participating home healthcare agencies have demonstrated commitment to this research partnership and have already trained their staff in Cornell's "Training in the Assessment of Depression" (TRIAD). A total of 100 nurses will be randomized by pre-existing teams to CAREPATH or usual care. The impact of CAREPATH on Depression Treatment will be tested with all eligible patients (N~1,000) using data collected routinely by all agencies as these are the kinds of data that agencies typically use for quality assurance. Depressive Symptoms outcomes will be tested using the Hamilton Depression Rating Scale (HDRS) collected by researcher staff from (N=500) patients who consent to in-person baseline and telephone follow-up interviews at 12 and 24 weeks. If effective, the CAREPATH intervention could reduce the rates of unaddressed depression among elders who use homecare. At the agency level, CAREPATH could be sustained by the participating agencies and disseminated to other interested homecare agencies nation-wide.