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风险因素的整合管理发展一个流行病学基础。患有糖尿病抑郁症患者的同胞更可能患有糖尿病并发症，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，生物心理社会的方法提供经验基础，以照顾受糖尿病和重大抑郁症患者的200万美国人。这项研究将基于对4839名糖尿病患者（GHC）评估糖尿病，抑郁症，残疾以及糖尿病和心脏病相关危险因素的完整调查。我们将对所有幸存者进行为期5年的随访调查，以评估抑郁症和残疾结果，以及患者护理的重点。我们将使用GHC和华盛顿州死亡记录来衡量死亡率。血糖，血压和脂质控制，糖尿病并发症以及医疗保健质量将在五年的随访期内使用GHC病历进行监测。 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日常生活和重大抑郁症。主要重点是抑郁症对不良糖尿病结局的贡献。目标2：确定抑郁症与糖尿病患者的卫生保健差异。我们将评估抑郁糖抑制剂合并症是否与医疗保健质量的差异有关：临床控制（血压，血压和脂质控制）；预防性筛查和治疗；以及减少行为风险因素（肥胖，久坐的生活方式和戒烟的干预措施）。 AIM 3：设定集成服务的优先级 - 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相关的优先级相关的标准。