IMPROVING CARE FOR DEPRESSION

改善抑郁症护理

• 批准号: 2250078
• 负责人: LISA V RUBENSTEIN
• 金额: $ 62.75万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 1995
• 资助国家: 美国
• 起止时间: 1995-09-15 至 2000-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2250078
• 关键词: clinical trials; cooperative study; decision making; health care cost /financing; health care model; health care personnel performance; health care policy; health care professional practice; health care quality; health care service evaluation; health care service organization; health care service utilization; human subject; longitudinal human study; major depression; mental health services; patient care personnel attitude; peer group; primary care physician; satisfaction

Major depression is common, debilitating, underrecognized, and undertreated. Most individuals who do get treatment are cared for solely in primary care settings. Clinical practice guidelines for depression, in combination with team-based quality improvement (QI) for implementing them, offer a potentially valuable tool for improving clinical care and health outcomes for depressed patients. The main purpose of this study is to determine whether team-based quality improvement approaches are more effective than guideline distribution alone for increasing adherence to guidelines for primary care patients with major depression. As a secondary purpose, we will assess two common variants of team-based QI. One of the team-based QI models is more centrally-managed, while the other is more locally managed. We will thus learn about how, whether, and why team-based QI works. We propose a randomized clinical trial in 9 group-practice sites comparing the central expert (CE) form of QI and the local peer (LP) form of QI to distribution alone as methods for implementing the recently-published Agency for Health Care Policy and Research clinical practice guidelines for depression in primary care. We will evaluate the two QI models in 6 sites (4 autonomous practices within Kaiser Permanente of Northern California and 2 firm (team) practices at the Sepulveda VA Medical Center) against a control condition--guideline distribution--in 3 sites (2 Kaiser and 1 Sepulveda VA practice). The QI approaches will be implemented over a 10 month period. To evaluate the effectiveness of the QI approaches, we will enroll 750 depressed patients during the post intervention period, distributed across study sites. We will assess patient health status (including severity of depression) and the quality of the process of care for depression for both samples. We will follow these patients for 12 months to determine their health and cost outcomes and their satisfaction with care. We will also assess health and cost outcomes and their satisfaction with care. We will also assess health care provider attitudes and knowledge, as well as any organizational features that affect the success of the interventions. The study will thus generate new knowledge about guidelines implementation for depression, quality improvement methods, and the barriers and resources for depression care in primary care settings.

重度抑郁很常见，使人衰弱，不认可，并且 治疗不足。大多数获得治疗的人都只照顾 在初级保健环境中。抑郁症临床实践指南， 结合实施的基于团队的质量改进（QI） 他们提供了一种潜在的有价值的工具来改善临床护理和 抑郁症患者的健康结果。这项研究的主要目的是 确定基于团队的质量改进方法是否更多 比单独的指南分布有效，以提高依从性 大抑郁症的初级保健患者指南。作为 次要目的，我们将评估两个基于团队的气的常见变体。 基于团队的QI模型之一是更集中管理的，而另一个 是在本地管理的。因此，我们将了解如何，是否以及为什么 基于团队的Qi作品。 我们在9个小组实践地点提出了一项随机临床试验，以比较 Qi的中央专家（CE）形式和当地同行（LP）Qi形式 仅分发作为实施最近发布的方法 卫生保健政策和研究局临床实践指南 用于初级保健的抑郁症。我们将在6中评估两个Qi模型 站点（北部Kaiser Permanente内的4种自主做法 加利福尼亚和2个公司（团队）练习在塞普维达弗吉尼亚州医疗中心） 在3个地点（2个Kaiser） 和1 Sepulveda VA实践）。 QI方法将被实施 一个10个月的时间。为了评估QI方法的有效性，我们 在干预后，将招募750名抑郁症患者， 分布在研究地点。我们将评估患者健康状况 （包括抑郁的严重程度）和护理过程的质量 两个样品的抑郁症。我们将跟随这些患者12 确定其健康和成本成果和满意度的月份 小心。我们还将评估健康和成本成果及其 对护理的满意。我们还将评估医疗保健提供者 态度和知识以及任何组织特征 影响干预措施的成功。因此，该研究将产生新的 有关抑郁，质量实施准则的知识 改进方法以及抑郁症护理的障碍和资源 初级保健设置。