Depression Care Among Elderly Nursing Home Residents

老年疗养院居民的抑郁症护理

• 批准号: 6906670
• 负责人: Stephen Crystal
• 金额: $ 30.8万
• 依托单位: RUTGERS, THE STATE UNIV OF N.J.
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-26 至 2009-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6906670
• 关键词: Medicare /Medicaid; antidepressants; behavioral /social science research tag; clinical depression; clinical research; comorbidity; geographic difference; health care facility information system; health care service evaluation; health care service utilization; health disparity; health services research tag; human data; human old age (65+); human subject; longitudinal human study; mental disorder chemotherapy; mental disorder diagnosis; mental health services; nursing homes; psychological aspect of aging; racial /ethnic difference; socioeconomics; statistics /biometry

DESCRIPTION (provided by applicant): Depression has pervasive effects on quality of life and health outcomes for elderly nursing home (NH) residents, but existing care processes are poorly understood and the knowledge base for improvement is inadequate. This study will provide a comprehensive assessment of patterns of depression identification and treatment for elderly residents, using merged data from the Minimum Data Set (MDS), Medicare and Medicaid claims, the OSCAR database on facility characteristics, and information on community characteristics in 6 states. The research dataset will integrate extensive clinical information from MDS with details on health and mental health services use, diagnoses, and pharmaceutical use histories from claims, along with contextual information on facilities that will relate care of individuals to other aspects of nursing facility care and life. The study aims to provide a clearer understanding of variations across facilities and communities in depression-related care processes, and to articulate the effects of facility structure, resources, case-mix, and practice patterns on resident care and outcomes. It will examine patterns of identified depression symptoms and diagnoses; antidepressant treatment; use of mental health services; and their interrelationships. An important focus will be on the analysis of racial/ethnic and other socioeconomic and geographical disparities, and identification of policy-modifiable and other factors that give rise to them. Trends in depression identification and treatment from 1999 through 2007 will be evaluated, including changes following public release via the Internet of a facility-level depression quality measure by CMS in 2004. Longitudinal analyses will evaluate trajectories of depression-related resident outcomes over time. Guided by a conceptual framework that articulates hypothesized processes leading to depression identification, treatment, and outcomes in a process of interaction among resident, facility, and community factors, the study will use multilevel modeling techniques that account for clustering of repeated observations within residents, residents within facilities, and facilities within communities.

描述（由申请人提供）：抑郁症对老年疗养院 (NH) 居民的生活质量和健康结果具有普遍影响，但人们对现有护理流程知之甚少，而且改善的知识基础也不足。本研究将使用来自最小数据集 (MDS)、医疗保险和医疗补助索赔、OSCAR 设施特征数据库以及 6 个州社区特征信息的合并数据，对老年居民的抑郁症识别和治疗模式进行全面评估。研究数据集将整合来自 MDS 的广泛临床信息、健康和心理健康服务使用、诊断和索赔中的药物使用历史的详细信息，以及将个人护理与护理机构护理和生活其他方面联系起来的设施背景信息。该研究旨在更清楚地了解不同设施和社区在抑郁症相关护理过程中的差异，并阐明设施结构、资源、病例组合和实践模式对居民护理和结果的影响。它将检查已识别的抑郁症症状和诊断的模式；抗抑郁治疗；使用心理健康服务；以及它们之间的相互关系。一个重要的重点将是分析种族/民族和其他社会经济和地理差异，并确定可修改的政策和其他导致这些差异的因素。将评估 1999 年至 2007 年抑郁症识别和治疗的趋势，包括 CMS 于 2004 年通过互联网公开发布设施级抑郁症质量测量后的变化。纵向分析将评估随着时间的推移，与抑郁症相关的住院医师结果的轨迹。该研究以一个概念框架为指导，阐述了在居民、设施和社区因素之间相互作用的过程中导致抑郁症识别、治疗和结果的假设过程，该研究将使用多层次建模技术来解释居民、居民中重复观察的聚类设施内以及社区内的设施。