Integrated Tele-Behavioral Activation and Fall Prevention for Low-income Homebound Older Adults with Depression

针对低收入居家抑郁症老年人的综合远程行为激活和跌倒预防

基本信息

批准号：
10630340
负责人：
NAMKEE G CHOI
金额：
$ 61.9万
依托单位：
UNIVERSITY OF TEXAS AT AUSTIN
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-06-26 至 2026-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10630340
关键词：
Acceleration Address Admission activity Adoption Aging Behavioral COVID-19 Case Management Chronic Disease Clinic Clinical Clinical Trials Clinical effectiveness Communities Consent Cost Effectiveness Analysis Data Disparity Education Effectiveness Elderly Emergency department visit Exercise Fall prevention Frequencies Hamilton Rating Scale for Depression Health Health Care Costs Healthcare Home Hospitals Hybrids Improve Access Income Infrastructure Institutionalization Intervention Lead Left Licensing Link Low Income Population Low income Managed Care Measures Mediation Medicare Medicare/Medicaid Mental Depression Mental Health Modeling Nursing Homes Outcome Participant Pharmacotherapy Physical therapy Pilot Projects Polypharmacy Population Population Group Pragmatic clinical trial Prevention program Professional counselor Provider Psychotherapy Public Health Quality of life Quality-Adjusted Life Years Randomized Research Risk Risk Factors Role Schedule Self Care Service delivery model Services Social Work Social isolation Source Suicide System Telephone Texas Training Transportation Underserved Population United States Centers for Medicare and Medicaid Services World Health Organization Disability Assessment Schedule access disparities aged aging population arm attentional control budget impact care coordination care systems chronic pain community living cost cost effective cost effectiveness delivered meals depressive symptoms disability disparity reduction evidence base fall injury falls fear of falling follow-up frailty geriatric mental health health care service health service use improved incremental cost intervention delivery mortality peer pragmatic trial premature prevention service primary outcome problem solving therapy programs psychosocial racial diversity satisfaction secondary outcome skills social social engagement socioeconomic disadvantage success symposium uptake

项目摘要

PROJECT SUMMARY Depression and falls are significantly higher in low-income, racially diverse homebound seniors than in the general older-adult population; however, the existing systems of care are not equipped to address disparities in mental health and fall prevention services for these vulnerable older adults. The long-term objective of the proposed study is to improve access to depression treatment and fall prevention for growing numbers of low- income homebound seniors. Specific aims are to compare clinical and cost effectiveness of integrated tele- delivered behavioral activation (Tele-BA) and fall prevention (FP) by bachelor’s-level lay counselors/coaches to Tele-BA or FP alone and attention control (AC). The current and projected shortages of licensed clinicians and the costs of deploying highly trained professionals pose barriers to providing services to older adults in general and low-income homebound seniors in particular. A more scalable option is to utilize lay counselors/coaches, and our recent clinical trial (1R01MD009675) and a FP pilot study show that lay counselors/coaches are as effective as licensed clinicians. The study participants will be 320 low-income, racially diverse homebound seniors who are served by a home-delivered meal (HDM) program and other aging-service agencies in Central Texas. The lay counselors/coaches will be co-located in the HDM program for seamless referral and care coordination. In a 4-arm, pragmatic clinical trial with randomization prior to consent (a preferred public health approach), the participants in the integrated Tele-BA and FP (TBF hereafter) arm will receive 5 Tele-BA sessions and 4 in-home FP sessions. Those in the Tele-BA or FP alone arms will receive the respective intervention and 4 bimonthly telephone check-in (booster) calls, and those in the AC arm will receive 5 weekly telephone check-in calls followed by 4 bimonthly follow-up calls. Study hypotheses are: At 12, 24, and 36 weeks after baseline, (1) TBF will be more effective than Tele-BA or FP alone, and Tele-BA or FP alone will be more effective than AC in reducing depression (the 24-item Hamilton Rating Scale for Depression), falls, and fall injuries; (2) TBF than Tele-BA alone or FP alone will be more effective in reducing disability (WHODAS 2.0) and healthcare and social service use; and (3) TBF will be more cost effective than Tele-BA alone or FP alone. Cost-effectiveness analysis (CEA) will be based on depression free days, prevented falls, and health-related quality adjusted life-year measured by EuroQol-5 (EQ-5D). We will also conduct budget impact analysis (BIA) of TBF relative to Tele-BA or FP. Both CEA and BIA will employ a hybrid public program perspective of the Administration for Community Living and the Centers for Medicare and Medicaid. Public health significance of this study is that it will provide empirical data needed for real-world adoption of an intervention delivery model that targets to intervene for the two most frequent sources of disability acceleration and healthcare use among a rapidly growing, underserved population. (We use the terms older adults and seniors interchangeably because the latter term is frequently used in aging services.)

项目概要低收入、种族多元化的居家老年人的抑郁和跌倒发生率明显高于其他群体然而，现有的护理系统没有能力解决老年人口中的差异问题。为这些弱势老年人提供心理健康和跌倒预防服务是该组织的长期目标。拟议的研究旨在改善越来越多的低收入人群获得抑郁症治疗和跌倒预防的机会具体目标是比较综合远程治疗的临床和成本效益。由学士级非专业顾问/教练提供行为激活 (Tele-BA) 和跌倒预防 (FP) 单独的 Tele-BA 或 FP 以及注意力控制 (AC) 当前和预计的许可和顾客短缺。部署训练有素的专业人员的成本对向一般老年人提供服务构成了障碍尤其是低收入居家老年人，更可扩展的选择是利用非专业辅导员/教练，我们最近的临床试验 (1R01MD009675) 和 FP 试点研究表明，非专业辅导员/教练与研究参与者将是 320 名低收入、多种族的居家牧师。接受上门送餐 (HDM) 计划和中环其他老龄服务机构服务的老年人德克萨斯州，非专业顾问/教练将在 HDM 计划中同地办公，以实现无缝转介和护理。在同意之前进行随机化的四组务实临床试验中（首选公共卫生）。方法），综合 Tele-BA 和 FP（以下简称 TBF）部门的参与者将收到 5 Tele-BA 单独参加 Tele-BA 或 FP 组的人员将分别接受 4 次家庭 FP 课程和 4 次家庭 FP 课程。干预和每两个月一次的 4 次电话登记（加强）电话，AC 部门的人员每周将收到 5 次电话登记后，每两个月进行 4 次随访研究假设为：12 点、24 点和 36 点。基线后几周，(1) TBF 将比单独使用 Tele-BA 或 FP 更有效，并且单独使用 Tele-BA 或 FP 将更有效。在减少抑郁（24 项汉密尔顿抑郁量表）、跌倒和抑郁方面比 AC 更有效 (2) TBF 比单独的 Tele-BA 或单独的 FP 在减少残疾方面更有效（WHODAS 2.0）以及医疗保健和社会服务的使用；(3) TBF 比单独的 Tele-BA 或单独的 FP 更具成本效益。成本效益分析 (CEA) 将基于无抑郁日、预防跌倒以及与健康相关的情况通过 EuroQol-5 (EQ-5D) 衡量的质量调整生命年我们还将进行预算影响分析 (BIA)。 TBF 相对于 Tele-BA 或 FP 而言，CEA 和 BIA 都将采用混合公共计划视角。社区生活管理局以及医疗保险和医疗补助中心的公共卫生意义。这项研究的目的是，它将提供现实世界采用干预实施模型所需的经验数据其目标是对残疾加速和医疗保健使用的两个最常见的来源进行干预快速增长的、服务不足的人口（我们使用术语“老年人”和“老年人”）。因为后一个术语经常用于老化服务。）