Improving Quality and Outcomes for Low Income Children with Depression in the US

提高美国低收入抑郁症儿童的质量和结果

• 批准号: 10446491
• 负责人: Cynthia Ann Fontanella
• 金额: $ 39.58万
• 依托单位: RESEARCH INST NATIONWIDE CHILDREN'S HOSP
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10446491
• 关键词: Improving; Quality; Outcomes; Low; Income

ABSTRACT Reducing suicide deaths and premature mortality among youth with depression has been identified as a national priority and important goal for health systems. Effective, evidence-based pharmacological and psychosocial therapies exist to treat pediatric depression and clinical practice guidelines, quality indicators, and medication algorithms have been developed in an effort to apply evidence-based practices to its real-world management. Unfortunately, little is known about the degree to which the depression care delivered to publicly insured youth meets existing quality standards, and these widely accepted standards have not been properly validated, meaning that the impact of care meeting quality standards on important patient outcomes such as recurrence of depression, self-harm, suicide, and overall mortality is essentially unknown. Relatedly, although the landmark Patient Protection and Affordable Care Act (ACA) expanded Medicaid eligibility and mandated that mental health services be included as basic Medicaid services, whether expanded insurance coverage for Medicaid enrolled youth has improved depression care quality and/or outcomes is unknown. Specific aims of this proposed study are three-fold: 1) to identify patient, provider, community and system factors associated with guideline concordant care for youth with major depressive disorder (MDD); 2) to determine whether guideline concordant care is associated with depression recurrence, self-harm, suicide, and all-cause mortality; and 3) to determine the effect of state Medicaid expansion under ACA on access to and quality of care for Medicaid enrolled youth with MDD. We propose to conduct a retrospective longitudinal cohort study using national Medicaid data linked with National Death Index records of all youth aged 10-17 (N= 350,00) with new episodes of MDD between 2015 and 2019. These youth will be followed for up to 24 months up until 2019. Cox regression models will be used to examine the association between 12 -month mortality and 5 patient-level quality measures, while risk-adjusting for patient characteristics using propensity score methods. Quality measures include: 1) effective antidepressant management during the acute phase; 2) effective antidepressant management during the continuation phase; 3) adequate antidepressant dosage; 4) optimal provider contacts among those taking antidepressants; and 5) adequate dose of psychotherapy. The contribution of the proposed research is expected to be an increased understanding of factors that impact adherence to quality of care treatment guidelines for depression. In addition, the proposed study will help narrow the gap between community practice and optimal care by determining which recommended clinical practice guidelines improve critical outcomes for youth with MDD. This contribution will be significant because understanding factors associated with adherence to guideline concordant care will enhance our ability to develop models of interventions to modify those factors and processes to increase adherence.

抽象的 减少抑郁症青年的自杀死亡和早亡率过早已被确定为 国家优先和卫生系统的重要目标。有效，基于证据的药理和 存在社会心理疗法来治疗小儿抑郁和临床实践指南，质量指标和 为了将基于证据的实践应用于现实世界，已经开发了药物算法 管理。不幸的是，关于抑郁症护理公开提供的程度知之甚少 被保险的青年符合现有的质量标准，这些被广泛接受的标准尚未正确 经过验证，这意味着，护理的影响达到质量标准对重要患者结果的影响 抑郁，自我伤害，自杀和整体死亡率的复发本质上是未知的。虽然相关 具有里程碑意义的患者保护和负担得起的护理法（ACA）扩大了医疗补助资格并要求 该精神卫生服务作为基本医疗补助服务包括在内 医疗补助的年轻人改善了抑郁症护理质量和/或结果，尚不清楚。具体目标 这项拟议的研究是三个方面的：1）确定患者，提供者，社区和系统因素 有针对重度抑郁症的青年（MDD）的指南协调； 2）确定是否 指南协调与抑郁症复发，自我伤害，自杀和全因死亡率有关； 3）确定ACA下的国家医疗补助扩展对获得和质量的影响 Medicaid招募了MDD的青年。我们建议使用使用的回顾性纵向队列研究 国家医疗补助数据与所有10-17岁（n = 350,00）的国家死亡指数记录有关 2015年至2019年之间的MDD剧集。这些年轻人将在2019年之前长达24个月。 回归模型将用于检查12个月死亡率与5个患者级别之间的关联 质量度量，同时使用倾向分数方法对患者特征进行风险调整。质量 措施包括：1）在急性期有效的抗抑郁药； 2）有效抗抑郁药 在延续阶段的管理； 3）足够的抗抑郁剂量； 4）最佳提供商联系人 在服用抗抑郁药的人中； 5）足够的心理治疗剂量。贡献 预计拟议的研究将是对影响遵守质量质量的因素的一种越来越多的理解 抑郁症的护理治疗指南。此外，拟议的研究将有助于缩小 通过确定哪些建议的临床实践指南改善了社区实践和最佳护理 MDD青年的关键结果。这项贡献将是重要的，因为了解因素 与遵守指南和协调护理相关的将增强我们开发模型的能力 修改这些因素和过程以提高依从性的干预措施。