This application responds to PAR 10-038 """"""""Dissemination and Implementation Research in Health"""""""", an initiative focused on the """"""""gap"""""""" between the production of evidence-based interventions and their use in the """"""""real world"""""""". This problem is exacerbated in organizations like Home Health as most agencies are small, decentralized and geographically dispersed. Few can afford advanced quality improvement. This situation is not unique to Home Health (HH) as much the nation's health care is provided by resource-poor public and not-for-profit agencies. This study tests the effectiveness of a web-based implementation strategy (MHTraining-Net) on the Depression CAREPATH, a HH intervention based on the Collaborative Depression Care model. CAREPATH integrates the model's depression care management functions into routine practice of HH nurses, including: a. Monitoring depression severity;b. Consultation about medication and/or psychotherapy treatment;c. Medication management;d. Education;and e. Patient goal setting around self care, pleasurable activities and social contact. MHTraining-Net employs e-learning modules, webinars, email/phone consultation, and social networking technology to deliver four implementation activities: 1. Infrastructure development, 2. Training, 3. Supervision/performance feedback, and 4. Social learning. The effect of MHTraining-Net on implementing CAREPATH will be compared to an Enhanced Support condition. The study uses an agency-randomized design, with 60 HH agencies per arm. All HH agencies are clients of CareAnyware, Inc, a company that provides web-based clinical management software. The CAREPATH protocol is already programmed into this software and accessible to all agencies. The study will analyze routinely collected data from an estimated 7,800 older patients with clinically significant depression (PHQ-9>15).
The aims are to test the effectiveness of MHTraining-Net on: 1. Changing Practice: increasing nurse adherence to the CAREPATH protocol;and 2. Changing Patients'Outcomes: reducing severity of depression. Pilot data suggest that MHTraining-Net is feasible, acceptable to HH agencies, and positively affects both patient care and clinical outcomes. Depression affects over 25% of older HH patients, is mostly undetected or poorly treated, and leads to worse health outcomes and higher healthcare costs. The study takes advantage of technological advances to design an implementation strategy that can reach decentralized, geographically dispersed agencies, and a research strategy that couples the power of an agency-randomized trial with the generalizability of a large, diverse patient population. Given its long reach, MHTraining-Net has the potential of significantly improving care for depression in older HH patients and reducing the public health burden of depression in this population.

Public Health Relevance

The problem addressed by this study is that many home healthcare agencies do not have the support they need to implement evidence-based practices because they are often small, independent, and geographically dispersed. This study tests the effectiveness of an implementation strategy designed to provide long distance help to agencies in improving care and reducing the burden of clinically significant depression in older patients.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH096441-03
Application #
8703793
Study Section
Dissemination and Implementation Research in Health Study Section (DIRH)
Program Officer
Chambers, David A
Project Start
2012-08-15
Project End
2016-07-31
Budget Start
2014-08-01
Budget End
2015-07-31
Support Year
3
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Weill Medical College of Cornell University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
City
New York
State
NY
Country
United States
Zip Code
10065
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Bruce, Martha L; Lohman, Matthew C; Greenberg, Rebecca L et al. (2016) Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30- and 60-Day Hospitalization: The Depression Care for Patients at Home Cluster-Randomized Trial. J Am Geriatr Soc 64:2196-2203
Bruce, Martha L (2016) New strategies to improve both effectiveness and access to care. Lancet Psychiatry 3:490-1
Lohman, Matthew C; Raue, Patrick J; Greenberg, Rebecca L et al. (2016) Reducing suicidal ideation in home health care: results from the CAREPATH depression care management trial. Int J Geriatr Psychiatry 31:708-15

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