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）是一个普遍且日益严重的健康问题，影响了500万美国人，每年有超过550,000例新诊断的病例，287,000例死亡和300亿美元的直接和间接费用。尽管私人和公共付款人正在采用许多护理管理计划，但CHF患者仍会经历较差的结果。这些不良结果的潜在贡献是抑郁症的存在，大约有20-50％的CHF患者存在。有效的慢性疾病管理的类似原则适用于抑郁症和CHF。因此，我们建议，筛查CHF患者抑郁症，然后利用在医生的监督下工作的单个护士护理经理，同时为两种疾病提供基于证据的治疗方法，而当存在是一种新颖的且潜在的可持续性策略，以改善临床结果，而不是推荐抑郁症的CHF患者分离抑郁症患者。从干预开发到服务，我们修订了三年的R34治疗开发建议对NIMH PAR-06-248响应，因为其具体目的是获得规划大规模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护理管理计划的有效性与当前CHF护理管理计划的临时型号，以改善各种问题，并改善了其他范围的其他症状。它由四个协调阶段组成：（1）培训；（2）手动开发；（3）队列研究；（4）试点干预。我们将从目前的NIH资助的试验中派出护士招聘者/护理经理，以治疗CABG后抑郁症，以在两个本地住院和门诊的CHF护理管理计划中进行培训。随后，我们将整合得出的协作护理方案，用于治疗早期工作中开发的抑郁症，并与基于指南的CHF方案进行处理。接下来，我们将进行一项队列研究，以估算372名抑郁症和100名不抑郁的CHF患者的招募和“常规护理”治疗模式。将对ROC分析进行应用，以估计适当敏感和特定的PHQ-9截止分数，以识别可能在6个月后随访时死亡或重新住院的抑郁症患者。最后，我们将向30名CHF患者进行基于电话的“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