Cost of an Evidence Based Depression Care Management Intervention in Home Health

家庭健康中基于证据的抑郁症护理管理干预的成本

基本信息

批准号：
7739977
负责人：
Yuhua Bao
金额：
$ 8.45万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-06-15 至 2011-04-30
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): Despite the burden of depression in home health care, very few home health patients receive guideline-concordant depression treatment. Lack of economic incentives constitutes a major barrier to the implementation of evidence-based depression treatment models in general medical settings including home health care. The NIMH-funded "Homecare Depression Care path" (CAREPATH) randomized controlled trial will test the effectiveness of an evidence- based depression care management intervention tailored to the home health setting versus usual care. The goal of this proposed research is to understand the economic incentives for adopting the CAREPATH intervention by home health agencies (HHAs). The specific aims are: 1) to assess the incremental cost to HHAs of delivering the CAREPATH intervention to clinically depressed home health patients, including CAREPATH training cost, cost of nurse time devoted to CAREPATH intervention and the cost impact of changes, if any, in the number and types of home health visits as a result of the intervention; and 2) to estimate incremental payments associated with the CAREPATH intervention under the current Medicare home health prospective payment system (PPS) and compare these payments to the cost of the intervention. Data for this project will come from linked home health administrative databases assembled by the CAREPATH study and study nurse self-reports of time spent on CAREPATH activities. We will leverage the randomized controlled design of the CAREPATH study to estimate incremental visit costs and incremental payment associated with the CAREPATH intervention at the level of home health payment episode, taking into account the multi-level nature of the data (episodes, patients, nurses and nurse teams). Results of the study will inform the decisions of HHAs in adopting the CAREPATH intervention if it is found to be effective, thus addressing a prominent barrier to the implementation of evidence-based depression care in routine medical practices. Findings will also inform the design of Medicare payments that can encourage the provision of effective depression treatment in home health care. PUBLIC HEALTH RELEVANCE: Depression among older home health care patients is prevalent and costly, but seriously under- recognized and undertreated. The proposed study will estimate, from the perspective of home health agencies (HHAs), the incremental costs and payments associated with a depression care management intervention currently being tested in home health care. Findings of this project will inform the decision of HHAs in providing evidence-based depression care and the design of Medicare payments that can encourage the provision of effective depression treatment in home health.

描述（由申请人提供）：尽管家庭保健中存在抑郁症的负担，但很少有家庭保健患者接受符合指南的抑郁症治疗。缺乏经济激励是在包括家庭医疗保健在内的一般医疗环境中实施循证抑郁症治疗模式的主要障碍。 NIMH 资助的“家庭护理抑郁症护理路径”(CAREPATH) 随机对照试验将测试针对家庭健康环境量身定制的循证抑郁症护理管理干预措施与常规护理的有效性。这项拟议研究的目标是了解家庭健康机构 (HHA) 采用 CAREPATH 干预措施的经济动机。具体目标是： 1) 评估 HHA 向临床抑郁的家庭健康患者提供 CAREPATH 干预的增量成本，包括 CAREPATH 培训成本、护士用于 CAREPATH 干预的时间成本以及变化（如果有）的成本影响。由于干预措施而进行的家庭健康检查的次数和类型； 2) 估计当前 Medicare 家庭健康预期支付系统 (PPS) 下与 CAREPATH 干预相关的增量支付，并将这些支付与干预成本进行比较。该项目的数据将来自由 CAREPATH 研究收集的链接家庭健康管理数据库以及研究护士花在 CAREPATH 活动上的时间的自我报告。我们将利用 CAREPATH 研究的随机对照设计来估计与家庭健康支付事件层面的 CAREPATH 干预相关的增量就诊成本和增量付款，同时考虑到数据的多层次性质（事件、患者、护士）和护士团队）。如果发现 CAREPATH 干预措施有效，研究结果将为 HHA 决定采用 CAREPATH 干预措施提供依据，从而解决在常规医疗实践中实施循证抑郁症护理的一个突出障碍。研究结果还将为医疗保险支付的设计提供信息，从而鼓励在家庭医疗保健中提供有效的抑郁症治疗。公共健康相关性：老年家庭保健患者中的抑郁症很普遍且成本高昂，但严重缺乏认识和治疗。拟议的研究将从家庭保健机构（HHA）的角度估计与目前在家庭保健中测试的抑郁症护理管理干预措施相关的增量成本和付款。该项目的研究结果将为 HHA 提供循证抑郁症护理的决定以及医疗保险支付的设计提供信息，从而鼓励在家庭健康中提供有效的抑郁症治疗。