Blended Collaborative Care for Heart Failure and Co-Morbid Depression

心力衰竭和共病抑郁症的混合协作护理

基本信息

批准号：
8437510
负责人：
BRUCE Lawrence ROLLMAN
金额：
$ 124.08万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-01 至 2018-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8437510
关键词：
Adherence Adopted Adult Advocate Affect Ambulatory Care American Ancillary Study Back Cardiac Cardiovascular Diseases Cardiovascular system Caring Case Manager Cessation of life Chronic Chronic Disease Clinical Clinical Research Complex Coronary Artery Bypass Depression screen Development Disease Disease Management EFRAC Effectiveness Elements Enrollment Event Failure Genomics Guidelines Health Care Costs Health Status Heart Heart failure Hospitalization Hospitals Incidence Inflammation Intervention Link Mediating Mediator of activation protein Medical Medical center Medicare Medicine Mental Depression Methods Moods Morbidity - disease rate New York Newly Diagnosed Operative Surgical Procedures Outcome Patients Pharmacotherapy Phase Physical Function Pilot Projects Primary Care Physician Protocols documentation Public Health Randomized Recommendation Recruitment Activity Resources Self Management Sleep Supervision Symptoms System Systolic heart failure Telephone Testing Universities Work base blood pressure regulation cardiovascular risk factor chronic care model clinical practice collaborative care comparative effectiveness compare effectiveness cost cost effective cost effectiveness depressive symptoms effectiveness trial evidence base experience follow-up functional status health care delivery health care service utilization health related quality of life high risk improved innovation medical specialties mortality multidisciplinary novel physical conditioning pragmatic trial programs public health relevance routine care routine practice treatment as usual treatment effect treatment program

项目摘要

DESCRIPTION (provided by applicant): Heart failure (HF) is an important public health problem that affects approximately 6.6 million Americans. Despite improvements in cardiac care, it remains the leading cause for hospitalization among Medicare patients and the only major cardiovascular disease whose mortality rate has remained essentially unchanged over the past decade. This failure to improve HF outcomes may be due, in part, to unrecognized and/or inadequately treated depression that is highly prevalent in HF patients. Yet while new HF treatment guidelines advocate routine screening for depression, this recommendation is unlikely to be widely adopted without trial evidence that depression care improves outcomes and efficient methods to provide it. "Collaborative care" strategies are being increasingly utilized t improve care for HF and other chronic medical conditions, and we recently demonstrated its clinical and cost-effectiveness at treating depression following coronary artery bypass graft surgery. Yet it may be impractical for health care delivery systems to support separate treatment programs for HF and depression. Thus we are encouraged by emerging evidence indicating "blended" collaborative care strategies that target both psychiatric and physical conditions produce greater improvements in mood symptoms and control of cardiovascular risk factors than programs focused solely on depression to propose testing a novel adaptation that could be provided in routine care. The Specific Aims of this Project are to: (1) evaluate the effectiveness of a telephone-delivered "blended" collaborative care intervention for treating HF and depression that could be adopted into routine clinical practice if proven effective; and (2) advance our understanding of the moderators and mediators of depression treatment on clinical outcomes. We will screen hospitalized patients with systolic HF for depression, and then randomize 625 who screen positive and have at least a moderately elevated level of depressive symptoms at two-weeks following hospital discharge to either: (1) collaborative care for treating both HF and depression ("blended"); (2) collaborative care for treating HF alone (enhanced usual care (eUC)); or (3) their doctors' "usual care" (UC). Additionally, we will enroll 125 non-depressed HF patients to better evaluate the benefits derived from treating depression (total N=750). Our co-primary hypotheses will test whether "blended" collaborative care can produce at 12-months follow-up a: (A) 0.50 effect size (ES) or greater improvement in health-related quality of life (HRQoL) vs. UC; and (B) 0.30 ES or greater improvement in HRQoL vs. eUC. Secondary hypotheses will evaluate the effects of our "blended" intervention on mood, functional status, adherence with guideline-consistent care, incidence of cardiovascular events, health care utilization, and costs. Improving chronic illness care for medically complex patients is one of the major challenges facing medicine today. We propose to test the effectiveness of an innovative, efficient, scalable, and sustainable intervention that could transform the way HF and other cardiovascular disorders are treated in routine practice.

描述（由申请人提供）：心力衰竭 (HF) 是一个重要的公共卫生问题，影响约 660 万美国人。尽管心脏护理有所改善，但它仍然是医疗保险患者住院的主要原因，也是过去十年死亡率基本保持不变的唯一主要心血管疾病。心力衰竭结局未能改善的部分原因可能是心力衰竭患者中普遍存在的抑郁症未被识别和/或治疗不当。然而，尽管新的心力衰竭治疗指南提倡对抑郁症进行常规筛查，但如果没有试验证据表明抑郁症护理可以改善结果并提供有效的方法，这一建议不太可能被广泛采用。 “协作护理”策略越来越多地用于改善心力衰竭和其他慢性疾病的护理，我们最近证明了其在治疗冠状动脉搭桥手术后抑郁症方面的临床和成本效益。然而，医疗保健服务系统支持心衰和抑郁症的单独治疗计划可能不切实际。因此，新出现的证据表明，与仅针对抑郁症的计划相比，针对精神和身体状况的“混合”协作护理策略可以在情绪症状和心血管危险因素控制方面产生更大的改善，这让我们感到鼓舞，建议测试一种可以在日常护理。该项目的具体目标是：（1）评估有效性电话提供的用于治疗心力衰竭和抑郁症的“混合”协作护理干预措施，如果证明有效，可以采用到常规临床实践中； (2) 加深我们对抑郁症治疗对临床结果影响的调节因素和中介因素的理解。我们将对患有收缩性心力衰竭的住院患者进行抑郁症筛查，然后将 625 名筛查呈阳性且在出院后两周内抑郁症状至少中度升高的患者随机分配至以下任一组：(1) 治疗心力衰竭和抑郁症的协作护理（“混合”）; (2) 单独治疗心力衰竭的协作护理（强化常规护理（eUC））； (3) 他们的医生的“常规护理”(UC)。此外，我们将招募 125 名非抑郁性心力衰竭患者，以更好地评估治疗抑郁症所带来的益处（总计 N=750）。我们的共同主要假设将测试“混合”协作护理是否可以在 12 个月的随访中产生： (A) 与 UC 相比，效果大小 (ES) 达到 0.50 或健康相关生活质量 (HRQoL) 得到更大改善； (B) 与 eUC 相比，HRQoL 提高 0.30 ES 或更大。次要假设将评估我们的“混合”干预对情绪、功能状态、遵循指南一致的护理、心血管事件发生率、医疗保健利用率和成本的影响。改善对病情复杂的患者的慢性病护理是当今医学面临的主要挑战之一。我们建议测试一种创新、高效、可扩展和可持续的干预措施的有效性，这种干预措施可以改变心衰和其他心血管疾病在常规实践中的治疗方式。