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，也是唯一的主要心血管疾病，其死亡率在过去十年中基本上保持不变。这种未能改善HF预后的情况可能部分归因于HF患者高度普遍的未识别和/或不充分治疗的抑郁症。然而，尽管新的HF治疗指南提倡常规筛查抑郁症，但如果没有试用证据表明，抑郁症护理可以改善结果和有效的方法，不太可能被广泛采用。越来越多地利用了“协作护理”策略，可以改善HF和其他慢性医疗状况的护理，最近我们证明了其在治疗冠状动脉搭桥后抑郁症方面的临床和成本效益。然而，对于医疗保健提供系统，支持HF和抑郁症的单独治疗计划可能是不切实际的。因此，我们受到新兴证据的鼓励，表明针对精神病和身体状况的“混合”协作护理策略比仅专注于抑郁症的计划来提出一种可以在常规护理中提供的新颖适应性的计划，从而在情绪症状和心血管危险危险因素的控制方面产生了更大的改善。该项目的具体目的是：（1）评估有效性如果证明有效的话，可以将电话交付的“混合”合作护理干预措施用于治疗HF和抑郁症；（2）提高我们对临床结果的抑郁症治疗的主持人和介体的理解。我们将筛查住院的HF病人的抑郁症患者，然后将625随机筛选为阳性，并在出院后两周的抑郁症状至少升高到中等升高的抑郁症状水平：（1）治疗HF和抑郁症的协作护理（“混合”）；（2）单独治疗HF的协作护理（增强的常规护理（EUC））；或（3）他们的医生的“通常护理”（UC）。此外，我们将招募125名未抑郁的HF患者，以更好地评估治疗抑郁症获得的益处（总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）0.50效应大小（ES）或与健康相关的生活质量（HRQOL）与UC的改善；（b）HRQOL与EUC的0.30 ES或更大的改进。次要假设将评估我们的“混合”干预措施对情绪，功能状况，遵守指南一致的护理，心血管事件的发生率，医疗保健利用率和成本的影响。改善医学复杂患者的慢性病护理是当今医学面临的主要挑战之一。我们建议测试创新，高效，可扩展和可持续干预的有效性，以改变HF和其他心血管疾病在常规实践中的处理方式。