Depression Care Among Elderly Nursing Home Residents

老年疗养院居民的抑郁症护理

• 批准号: 7100150
• 负责人: Stephen Crystal
• 金额: $ 30.08万
• 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/7100150
• 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）：抑郁症对老年养老院（NH）居民的生活质量和健康成果的抑郁症普遍存在，但对现有的护理过程的了解很少，并且改善知识库不足。这项研究将使用最低数据集（MDS），Medicare和Medicaid索赔的合并数据，有关设施特征的奥斯卡数据库以及有关6个州的社区特征的信息，对老年居民的抑郁识别和治疗方式进行全面评估。研究数据集将将MDS的广泛临床信息与有关健康和心理健康服务使用，诊断和药物使用历史的详细信息以及有关设施的上下文信息以及将个人护理与护理设施护理和生活的其他方面联系起来的上下文信息的详细信息。该研究旨在更清楚地了解与抑郁症相关的护理过程中设施和社区之间的变化，并阐明设施结构，资源，案例混合和实践模式对居民护理和结果的影响。它将检查确定的抑郁症状和诊断的模式；抗抑郁药；使用心理健康服务；以及他们的相互关系。一个重要的重点将是分析种族/种族和其他社会经济和地理差异，以及鉴定产生这些差异的政策可调制和其他因素。将评估从1999年到2007年的抑郁识别和治疗的趋势，包括通过CMS在2004年通过设施级抑郁级质量衡量的公众发布后的变化。纵向分析将评估随着时间的推移，纵向分析将评估与抑郁症相关的居民结果的轨迹。在一个概念框架的指导下，在居民，设施和社区因素之间相互作用的过程中阐明了假设的过程，从而导致抑郁症识别，治疗和结果，该研究将使用多层次建模技术，以占用多级建模技术来说明居民内部居民内部居民，设施内部设施以及社区内部设施的重复观察。