Developing A Collaborative Care Strategy for Depression and Co-Morbid CHF

制定针对抑郁症和共病 CHF 的协作护理策略

基本信息

批准号：
7615731
负责人：
BRUCE Lawrence ROLLMAN
金额：
$ 15.64万
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：
2007
资助国家：
美国
起止时间：
2007-05-10 至 2011-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7615731
关键词：
Academic Medical Centers Acute Address Adherence Adopted Affect American Anxiety Disorders Area Attention Cardiac Cardiovascular Diseases Cardiovascular system Care given by nurses Caring Case Manager Cessation of life Chronic Disease Clinical Clinical Data Clinical Research Clinical Trials Cohort Studies Congestive Heart Failure Coronary Artery Bypass Data Development Diagnosis Disease Management Effectiveness Enrollment Evidence based treatment Facilities and Administrative Costs Failure Funding Gender Guidelines Health Health Care Costs Health Planning Organizations Healthcare Heart Hospitalization Hospitals Individual Inpatients Intervention Left Managed Care Manuals Medical Medical center Morbidity - disease rate National Institute of Mental Health New York Newly Diagnosed Nurses Operative Surgical Procedures Outcome Outpatients Patient Self-Report Patients Pattern Phase Physicians Process Measure Protocols documentation Provider Psyche structure Quality of Care Race Reporting Research Personnel Resolution Resources Risk Screening procedure Services Severities Severity of illness Supervision Telephone Testing Training Treatment Protocols Universities Update Ventricular Work base clinically significant cohort collaborative care compare effectiveness depressed depression depressive symptoms effectiveness trial evidence base experience follow-up health care service utilization health related quality of life hospital readmission improved interest mortality novel physical conditioning primary care setting programs response routine practice therapy development treatment as usual treatment strategy

项目摘要

DESCRIPTION (provided by applicant): Congestive heart failure (CHF) is a common and growing health problem that affects 5 million Americans, with over 550,000 newly diagnosed cases, 287,000 deaths, and $30 billion in direct and indirect costs yearly. Despite a number of care management programs that are being adopted by private and public payers, CHF patients continue to experience poor outcomes. A potential contributor to these poor outcomes is the presence of depression, present in approximately 20-50% of CHF patients. Similar principles of effective chronic disease management apply to both depression and to CHF. Thus, we suggest that screening CHF patients for depression and then utilizing a single nurse care manager working under a physician's supervision to simultaneously deliver evidence-based treatments for both conditions when present is a novel and potentially more sustainable strategy for improving clinical outcomes than referring depressed CHF patients to separate care providers. Our revised three-year R34 treatment development proposal is responsive to NIMH PAR-06-248, From Intervention Development to Services, as its specific aims are to obtain the necessary feasibility and clinical data required to plan a large-scale R01 trial which will compare the effectiveness of a "blended" depression/CHF care management program with current CHF care management programs in reducing depressive symptoms, improving HRQoL, and various other outcomes of interest. It consists of four coordinated phases: (1) Training; (2) Manual Development; (3) Cohort Study; and (4) Pilot Intervention. We will send nurse-recruiter/care managers from our present NIH-funded trial to treat post-CABG depression for training in two local in-patient and out-patient CHF care management programs. We subsequently will integrate the stepped collaborative care protocols for treating depression we developed in our earlier work with guideline-based protocols for treating CHF. Next, we will conduct a cohort study to estimate recruitment and "usual care" treatment patterns for 372 depressed and 100 non-depressed CHF patients. ROC analyses will be applied so as to estimate suitably sensitive and specific PHQ-9 cut-off scores for identifying depressed patients who are likely to die or become rehospitalized at 6-month follow-up. Finally, we will pilot our telephone-based "blended" collaborative care strategy to 30 depressed CHF patients to further refine our treatment strategy.

描述（由申请人提供）：充血性心力衰竭 (CHF) 是一种常见且日益严重的健康问题，影响着 500 万美国人，每年有超过 550,000 例新诊断病例，287,000 例死亡，直接和间接费用达 300 亿美元。尽管私人和公共支付者正在采用许多护理管理计划，但慢性心力衰竭患者的治疗效果仍然不佳。导致这些不良结果的一个潜在因素是抑郁症的存在，约 20-50% 的 CHF 患者存在抑郁症。有效慢性病管理的类似原则适用于抑郁症和慢性心力衰竭。因此，我们建议对 CHF 患者进行抑郁症筛查，然后利用一名在医生监督下工作的护士护理经理，在存在两种情况时同时提供基于证据的治疗，这是一种新颖且可能比转诊抑郁症患者更可持续的改善临床结果的策略。 CHF 患者需要单独的护理提供者。我们修订后的三年 R34 治疗开发提案响应 NIMH PAR-06-248“从干预开发到服务”，因为其具体目标是获得计划大规模 R01 试验所需的必要可行性和临床数据，该试验将比较“混合”抑郁症/CHF 护理管理计划与当前 CHF 护理管理计划在减少抑郁症状、改善 HRQoL 和各种其他感兴趣的结果方面的有效性。它由四个协调的阶段组成： (1) 培训； (2) 手册开发； (3) 队列研究； (4) 飞行员干预。我们将从目前 NIH 资助的试验中派遣护士招聘人员/护理经理来治疗 CABG 后抑郁症，并参加两个当地住院和门诊 CHF 护理管理项目的培训。随后，我们将把我们在早期工作中制定的治疗抑郁症的阶梯式协作护理方案与基于指南的治疗 CHF 的方案整合起来。接下来，我们将进行一项队列研究，以评估 372 名抑郁症和 100 名非抑郁性 CHF 患者的招募和“常规护理”治疗模式。将应用 ROC 分析来估计适当敏感和具体的 PHQ-9 截止分数，以识别可能在 6 个月随访时死亡或再次住院的抑郁症患者。最后，我们将针对 30 名抑郁性 CHF 患者试点基于电话的“混合”协作护理策略，以进一步完善我们的治疗策略。

项目成果

期刊论文数量（3）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

A positive 2-item Patient Health Questionnaire depression screen among hospitalized heart failure patients is associated with elevated 12-month mortality.

住院心力衰竭患者的 2 项患者健康问卷抑郁筛查呈阳性与 12 个月死亡率升高相关。

DOI：
10.1016/j.cardfail.2011.11.002
发表时间：
2012
期刊：
Journal of cardiac failure
影响因子：
6
作者：
Rollman,BruceL;HerbeckBelnap,Bea;Mazumdar,Sati;Houck,PatriciaR;He,Fanyin;Alvarez,ReneJ;Schulberg,HerbertC;Reynolds3rd,CharlesF;McNamara,DennisM
通讯作者：
McNamara,DennisM