Improving CLTC System Response to Late Life Depression

改善 CLTC 系统对晚年抑郁症的反应

• 批准号: 7100594
• 负责人: ENOLA K PROCTOR
• 金额: $ 27.54万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-08 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7100594
• 关键词: behavioral /social science research tag; clinical research; communication; community mental health services; early diagnosis; extended care; functional ability; handbook; health care model; health care referral /consultation; health care service planning; health services research tag; home health care; human old age (65+); human subject; interdisciplinary collaboration; major depression; medical records; mental disorder diagnosis; mental health personnel; patient care management; primary care physician; psychological aspect of aging; psychosocial service

DESCRIPTION (provided by applicant): In response to NIMH PAR-03-078, "From intervention development to services: Exploratory Research Grants" (R34), we seek support to develop a system-level intervention for improving care for depressed older adults who receive publicly funded community long-term care (CLTC) services. Our goal is to develop a system improvement that is acceptable to and can be sustained in public CLTC. We will employ a staged model for intervention development drawing on both published research (global knowledge) and local knowledge of the system of care accrued through our 8 years of clinical epidemiological and service systems research. Specific Aims are to (1) Consolidate global knowledge (from published studies) and local knowledge (gained from prior work in the CLTC system) about (a) depression prevalence, course, and comorbidities; (b) stakeholder preferences for depression treatment, and (c) CLTC resources for responding to depression for purposes of deriving implications for intervention; (2) Engage an expert panel to use this knowledge to specify an intervention, "Assess, Link, and Support," to improve depression care in CLTC; (3) Develop treatment and training manuals; (4) Develop tracking methods for client and system outcomes; and (5) Assess the feasibility, acceptability, and appropriateness of the intervention and collect preliminary data for a subsequent effectiveness study. Quality improvement and organizational complexity theories inform the model of intervention development. Employing behavior aggregation methods, we will convene a multidisciplinary panel of local and national experts to vet a proposed intervention, specific ingredients which are based on theories of competing demands, the gateway filter linkage model, and motivational enhancement-readiness to change. This intervention development effort is responsive to recommendations of the President's New Freedom Commission Report on Mental Health (2003) to institute mental health screening and early intervention programs in public health and human services. Improving depression care through CLTC can extend mental health treatment to socially and economically disadvantaged elders, who historically have underutilized specialty mental health care. We will follow this work by an R01 study to test the intervention's effectiveness rigorously.

描述（由申请人提供）：响应NIMH PAR-03-078，“从干预开发到服务：探索性研究赠款”（R34），我们寻求支持以开发系统级干预措施，以改善获得公开资助的社区长期护理（CLTC）服务的抑郁老年人的护理。我们的目标是开发一个可以接受并可以在公共CLTC中维持的系统改进。我们将采用一个分阶段模型来开发干预开发（全球知识），以及在我们8年的临床流行病学和服务系统研究中所产生的护理系统的本地知识。具体目的是（1）巩固全球知识（从已发表的研究中）和本地知识（从CLTC系统中的先前工作中获得），涉及（a）抑郁症患病率，过程和合并症； （b）利益相关者对抑郁症治疗的偏好，以及（c）CLTC资源以响应抑郁症的资源，目的是导致对干预的影响； （2）聘请专家小组使用此知识来指定干预措施“评估，链接和支持”，以改善CLTC的抑郁症护理； （3）制定治疗和培训手册； （4）为客户和系统成果开发跟踪方法； （5）评估干预措施的可行性，可接受性和适当性，并收集初步数据以进行后续的有效性研究。质量改进和组织复杂性理论为干预开发模型提供了信息。采用行为汇总方法，我们将召集本地和国家专家的多学科小组，以审查拟议的干预措施，基于竞争要求的理论，网关滤波器链接模型以及动机增强的变化的精力准备。这项干预发展工作对总统新自由委员会关于心理健康的建议的建议（2003年）旨在提出公共卫生和公共服务中的心理健康筛查和早期干预计划。通过CLTC改善抑郁症护理可以将心理健康治疗扩展到社会和经济上不利的长辈，他们历来将专业精神卫生保健不足。我们将通过一项R01研究遵循这项工作，以严格测试干预措施的有效性。