Depression-Diabetes Care Disparities, Adverse Outcomes

抑郁症-糖尿病护理差异、不良后果

• 批准号: 6898110
• 负责人: Michael R Von Korff
• 金额: $ 49.01万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-04-11 至 2009-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6898110
• 关键词: behavior prediction; behavioral /social science research tag; cardiovascular disorder; clinical research; comorbidity; diabetes mellitus; health disparity; human subject; interview; longitudinal human study; major depression; managed care; medically underserved population; mental health epidemiology; outcomes research; patient care management; psychobiology; questionnaires

DESCRIPTION (provided by applicant): Our goal is to develop an epidemiological basis for integrated management of diabetes, depressive illness, and associated clinical and behavioral risk factors. Persons with diabetes depression co-morbidity are more likely to have diabetes complications, poorer clinical control, increased behavioral risk factors, and increased disability. The proposed research will provide an empirical basis for an integrated, biopsychosocial approach for care of the two million Americans afflicted by diabetes and major depression. This research will build on a completed survey of 4839 persons with diabetes in Group Health Cooperative (GHC) that assessed diabetes care, depression, disability, and associated risk factors for diabetes and heart disease. We will carry out a 5-year follow-up survey with all survivors to assess depression and disability outcomes, and patient priorities for their care. We will use GHC and Washington State death records to measure mortality. Glycemic, blood pressure, and lipid control, diabetic complications, and quality of health care will be monitored over the five-year follow-up period using GHC medical records. The research goal will be achieved by accomplishing three aims: Aim 1: Assess predictors of adverse outcomes - We will develop risk-prediction models for the incidence of adverse outcomes including: 5-year all-cause mortality, coronary disease (CAD) and cerebrovascular (CVA) mortality, incident microvascular and macrovascular complications, poor clinical control (glycemic, blood pressure and lipid control), deterioration in activities of daily living and major depression. A major focus will be the contribution of depression to adverse diabetes outcomes. Aim 2: Identify disparities in health care for depressed vs. non-depressed persons with diabetes. We will assess whether depression-diabetes co-morbidity is associated with disparities in the quality of health care for: clinical control (glycemic, blood pressure and lipid control); preventive screening and treatment; and for behavioral risk factor reduction (interventions for obesity, sedentary lifestyle, and smoking cessation). Aim 3: Set priorities for integrated services - We will assess criteria relevant to priorities for integrated management of diabetes, depression and associated behavioral risk factors.

描述（由申请人提供）：我们的目标是为糖尿病、抑郁症以及相关临床和行为危险因素的综合管理建立流行病学基础。患有糖尿病抑郁症共病的人更​​有可能出现糖尿病并发症、临床控制较差、行为危险因素增加以及残疾增加。拟议的研究将为综合的生物心理社会方法提供经验基础，以治疗 200 万患有糖尿病和重度抑郁症的美国人。这项研究将以团体健康合作社 (GHC) 中 4839 名糖尿病患者的完整调查为基础，该调查评估了糖尿病护理、抑郁、残疾以及糖尿病和心脏病的相关风险因素。我们将对所有幸存者进行为期 5 年的跟踪调查，以评估抑郁症和残疾结果以及患者护理的优先顺序。我们将使用 GHC 和华盛顿州死亡记录来衡量死亡率。将使用 GHC 医疗记录在五年的随访期内监测血糖、血压和血脂控制、糖尿病并发症以及医疗保健质量。研究目标将通过实现三个目标来实现： 目标 1：评估不良结果的预测因素 - 我们将开发不良结果发生率的风险预测模型，包括：5 年全因死亡率、冠心病 (CAD) 和脑血管疾病(CVA) 死亡率、微血管和大血管并发症、临床控制不佳（血糖、血压和血脂控制）、日常生活活动恶化和重度抑郁。主要关注点是抑郁症对糖尿病不良后果的影响。目标 2：确定患有糖尿病的抑郁症患者与非抑郁症患者在医疗保健方面的差异。我们将评估抑郁症-糖尿病共病是否与以下方面的医疗保健质量差异相关： 临床控制（血糖、血压和血脂控制）；预防性筛查和治疗；以及减少行为风险因素（针对肥胖、久坐生活方式和戒烟的干预措施）。目标 3：确定综合服务的优先事项——我们将评估与糖尿病、抑郁症和相关行为风险因素综合管理优先事项相关的标准。