Role of Depression in Medicare New Chronic Care Improvement Program

抑郁症在医疗保险新慢性病护理改善计划中的作用

• 批准号: 7221934
• 负责人: JURGEN UNUTZER
• 金额: $ 33.61万
• 依托单位: UNIVERSITY 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: 2005-08-15 至 2009-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7221934
• 关键词: Address; Adherence; Chronic; Chronic Care; Chronic Disease; Chronic Obstructive Airway Disease; Chronically Ill; Clinical; Clinical effectiveness; Complex; Condition; Congestive Heart Failure; Data; Diabetes Mellitus; Disease Management; Economics; Enrollment; Health Care Costs; Intervention; Managed Care; Medical; Medicare; Mental Depression; Modernization; Outcome; Patients; Pattern; Phase; Randomized Controlled Trials; Relative (related person); Role; Self Care; Services; Site; Target Populations; Time; Treatment Protocols; Work; Writing; base; beneficiary; cost; diet and exercise; programs; smoking cessation

DESCRIPTION (provided by applicant): We propose to evaluate the role of comorbid depression as a moderator of the clinical effectiveness and costs of Medicare's new Voluntary Chronic Care Improvement Program (CCIP), and to assess the value added of managing comorbid depression in this program. The Medicare Modernization Act of 2003 created the CCIP to manage care for Medicare beneficiaries with significant chronic illness. In its initial phase, the CCIP will implement three-year pilot programs in ten sites, targeting Medicare beneficiaries with congestive heart failure, complex diabetes, and/or chronic obstructive pulmonary disease. The pilot programs will be implemented as randomized control trials and will cover 15,000-30,000 beneficiaries per site. At the time of this writing, CMS is selecting organizations to provide CCIP services; patient enrollment begins in 2005. The CCIP is the first large-scale disease management initiative under the Medicare FFS program. It is also the largest-ever disease management trial for patients with comorbid depression, which is particularly prevalent (15%-25%) in the CCIP's target population. Chronically ill patients with comorbid depression have more severe medical illness, worse clinical outcomes, and higher health care costs than those without - which make them important potential targets for disease management. At the same time, patients with comorbid depression are harder to treat with conventional disease management programs that don't address depression, due to lower adherence to self-care (e.g., diet, exercise, smoking cessation) and medical regimens. This is likely to raise the costs and/or lower the benefits of disease management interventions for such patients, relative to patients with the same medical conditions but without comorbid depression. These patterns suggest that there may be considerable clinical and economic benefits from including specific strategies to address comorbid depression in disease management programs for chronic medical illness. We propose to investigate this by working with CMS to facilitate the integration of evidence-based depression management in the CCIP, and by analyzing patient- and organization-level data from the initial phase of the CCIP. Our findings will help CMS strengthen the CCIP and will help public and private policymakers implement effective disease management programs for chronic medical illness and comorbid depression.

描述（由申请人提供）：我们建议评估合并症抑郁症作为Medicare新的自愿性慢性护理改进计划（CCIP）的临床有效性和成本的主持人的作用，并评估该计划中合并抑郁症的增值。 2003年的《医疗保险现代化法》创建了CCIP，以管理患有严重慢性病的医疗保险受益人的护理。在其初始阶段，CCIP将在十个地点实施三年的试点计划，以充血性心力衰竭，复杂的糖尿病和/或慢性阻塞性肺部疾病为目标。试点计划将作为随机对照试验实施，每个站点将覆盖15,000-30,000名受益人。在撰写本文时，CMS正在选择提供CCIP服务的组织；患者入学率从2005年开始。 CCIP是Medicare FFS计划下的第一项大规模疾病管理计划。它也是有史以来最大的疾病管理试验，用于合并抑郁症患者，在CCIP的目标人群中尤其普遍（15％-25％）。慢性病患者的合并症患者比没有的患者患有更严重的医疗疾病，更严重的临床结果和更高的医疗费用，这使其成为疾病管理的重要潜在目标。同时，由于对自我保健（例如，饮食，运动，戒烟）和医疗方案的依从性较低，合并症抑郁症患者更难治疗无法解决抑郁症的常规疾病管理计划。相对于患有相同医疗状况但没有合并症的患者，这可能会提高和/或降低此类患者的疾病管理干预措施的收益。这些模式表明，包括针对慢性医学疾病的疾病管理计划中的合并症抑郁症的特定策略可能会带来可观的临床和经济利益。我们建议通过与CMS合作来调查这一点，以促进CCIP中基于证据的抑郁管理的整合，并从CCIP的初始阶段分析患者和组织级别的数据。我们的发现将有助于CMS加强CCIP，并有助于公共和私人决策者实施有效的疾病管理计划，以解决慢性医疗疾病和合并抑郁症。