Practice Redesign to Improve Depression Care - PRIDE Care

实践重新设计以改善抑郁症护理 - PRIDE Care

基本信息

批准号：
7771726
负责人：
David R. West
金额：
$ 28.69万
依托单位：
UNIVERSITY OF COLORADO DENVER
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：
2007-02-01 至 2012-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7771726
关键词：
Acute Address Adopted Adoption Affect Attention Belief Caring Characteristics Chronic Chronic Care Chronic Disease Clinical Clinical Trials Collaborations Communities Data Detection Development Diabetes Mellitus Disease Effectiveness Emotional Environment Feedback Guidelines Healthcare Human Resources Individual Intention Intervention Interview Lead Major Depressive Disorder Managed Care Measurement Measures Medical Mental Depression Mental Health Methods Modeling Morbidity - disease rate Motivation Nature Organ Outcome Patient Care Patients Physicians Populations at Risk Preventive Primary Care Physician Primary Health Care Procedures Process Process Assessment Qi Qualitative Methods Quality of Care Randomized Recruitment Activity Relative (related person)Research Personnel Resources Self Management Services Stress Structure Surveys System Testing Time Work arm base care systems chronic care model chronic depression design evidence base flexibility improved information processing innovation intervention effect mortality operation patient oriented population based prevent programs prospective randomized trial sound success tool treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Clinical trials have demonstrated the effectiveness of strategies for primary care management of depression, yet adoption of these strategies has been disappointing. This effectiveness study proposes a group randomized trial with intention to treat analysis to test two different approaches to quality improvement for depression (compared to usual care) in community-based primary care practices. Both interventions will be aimed at improving physician use of best practices for depression care. The Dep/QI targets depression using a QI model that was previously successful in providing practices with a process to initiate change and implement evidence-based depression care tools. A Dep/QI facilitator will work with practices in this arm to initiate QI procedures to address depression care. The Dep/QI facilitator will work with each practice over six months and assist the QI team with activities to strengthen the ability of the team to initiate depression interventions within the practice. The Chron/QI intervention assumes a broader focus and seeks to improve organizational capacity to implement chronic care systems that enable primary care physicians to provide evidence-based care for depression as well as other chronic conditions. The Chron/QI will incorporate an innovative Multimethod Assessment Process (MAP) to address critical barriers to improving a practice's capacity for providing chronic care for depression and capacity for making and sustaining change in practice operations. The MAP process has been used successfully to assess and feedback information on practice organization and functioning for preventive services and for diabetes care. A QI facilitator will work with the practices to process the information from the MAP assessment and form a QI team that includes key stakeholders (including patients) to address both organizational function of the practice and the development of office systems to support best practices depression care. Trial endpoints will be measured at baseline and six months to assess adoption and at 12 and 18 months to assess sustainability of intervention effects. Endpoints will include measures of change in practice structure and processes consistent with the chronic care model and demonstrated "best practices" for depression care received by patients with depression as assessed by chart audit. A multimethod assessment will analyze all qualitative and quantitative data separately to understand which components of the interventions were most effective and how they might be further improved, as well as how the practices used the two interventions and how intervention components interacted with key practice characteristics. A specific aim of the multimethod assess will seek to understand how primary care physicians and practices determine and act on the relative priority of depression care among the competing demands of primary care.

描述（由申请人提供）：临床试验证明了初级保健管理抑郁症的有效性，但采用这些策略令人失望。这项有效性研究提出了一项旨在治疗分析的小组随机试验，以测试基于社区的初级保健实践中抑郁症质量改善的两种不同方法。两种干预措施都将旨在改善医师对抑郁症护理的最佳实践的使用。 DEP/QI使用QI模型对抑郁症的靶向，该模型以前成功地提供了启动变更和实施基于证据的抑郁症护理工具的过程。 DEP/QI促进者将使用此部门的做法来启动QI程序以解决抑郁症护理。 DEP/QI主持人将在六个月内与每种实践一起工作，并协助Qi团队进行活动，以增强团队在实践中启动抑郁干预措施的能力。 CHRON/QI干预采用更广泛的重点，并试图提高组织能力来实施慢性护理系统，从而使初级保健医生能够为抑郁症以及其他慢性病提供基于证据的护理。 Chron/QI将纳入创新的多途径评估过程（MAP），以解决提高实践为抑郁症提供长期护理以及在实践操作中进行和维持变化的能力的关键障碍。该地图过程已成功地用于评估和反馈有关实践组织以及用于预防服务和糖尿病护理的功能的信息。 QI主持人将与这些实践合作处理地图评估中的信息，并组成一个QI团队，其中包括关键利益相关者（包括患者），以解决实践的组织功能和开发办公系统以支持最佳实践抑郁症护理。试验终点将在基线和六个月的时间进行测量，以评估采用率以及12个月和18个月的时间，以评估干预效果的可持续性。终点将包括与慢性护理模型一致的实践结构变化和过程的衡量标准，并证明了抑郁症患者接受的抑郁症护理的“最佳实践”。多方法评估将分别分析所有定性和定量数据，以了解干预措施的哪些组成部分最有效，以及如何进一步改善它们，以及实践如何使用两种干预措施以及干预组件如何与关键实践特征相互作用。多方法评估的一个具体目的将寻求了解初级保健医师和实践如何决定和采取基于初级保健竞争需求之间抑郁症护理的相对优先级。