The goal of this research is to improve depression treatment and outcomes among elderly home healthcare patients. Homecare nursing is a major source of health care for a large and growing number of medically ill or injured older adults who are homebound by illness or disability. We1 and others2 have documented that clinically significant depression is twice as prevalent in this patient population compared to similarly aged primary care patients. Depression can be effectively treated in older adults, and treatment guidelines have been developed to help physicians make treatment decisions for their depressed older patients. However, medical home healthcare patients rarely receive guideline-consistent treatment for depression. This application request funds to test the effectiveness of an intervention, """"""""Homecare Depression Carepath"""""""" (CAREPATH), on two outcomes: 1. Depression treatment (i.e., initiate treatment or have a change in treatment that is consistent with guidelines), and 2. Depressive symptoms (i.e., reduction in depressive symptoms over time). The CAREPATH protocol was designed in partnership with home healthcare providers. It includes the major elements of depression care management models that have proven effective in primary care but restructures these elements to fit the clinical needs of home healthcare patients and for consistency with home healthcare practice. The intervention itself is designed to be ecologically sensitive to maximize the feasibility and generalizability of the program. The CAREPATH Intervention will be tested within and among five homecare agencies located in Iowa, Michigan, New York City, Oklahoma and Upstate New York. The five participating home healthcare agencies have demonstrated commitment to this research partnership and have already trained their staff in Cornell's """"""""Training in the Assessment of Depression"""""""" (TRIAD). A total of 100 nurses will be randomized by pre-existing teams to CAREPATH or usual care. The impact of CAREPATH on Depression Treatment will be tested with all eligible patients (N~1,000) using data collected routinely by all agencies as these are the kinds of data that agencies typically use for quality assurance. Depressive Symptoms outcomes will be tested using the Hamilton Depression Rating Scale (HDRS) collected by researcher staff from (N=500) patients who consent to in-person baseline and telephone follow-up interviews at 12 and 24 weeks. If effective, the CAREPATH intervention could reduce the rates of unaddressed depression among elders who use homecare. At the agency level, CAREPATH could be sustained by the participating agencies and disseminated to other interested homecare agencies nation-wide.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Application #
Study Section
Mental Health Services in MH Specialty Settings (SRSP)
Program Officer
Azrin, Susan
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Budget End
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Weill Medical College of Cornell University
Schools of Medicine
New York
United States
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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
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; Raue, Patrick J; Reilly, Catherine F et al. (2015) Clinical effectiveness of integrating depression care management into medicare home health: the Depression CAREPATH Randomized trial. JAMA Intern Med 175:55-64
Bao, Yuhua; Eggman, Ashley A; Richardson, Joshua E et al. (2015) Practices of Depression Care in Home Health Care: Home Health Clinician Perspectives. Psychiatr Serv 66:1365-8
Pickett, Yolonda R; Bazelais, Kisha N; Greenberg, Rebecca L et al. (2014) Racial and ethnic variation in home healthcare nurse depression assessment of older minority patients. Int J Geriatr Psychiatry 29:1140-4
Pickett, Yolonda R; Ghosh, Samiran; Rohs, Anne et al. (2014) Healthcare use among older primary care patients with minor depression. Am J Geriatr Psychiatry 22:207-10
Raue, Patrick J; Ghesquiere, Angela R; Bruce, Martha L (2014) Suicide risk in primary care: identification and management in older adults. Curr Psychiatry Rep 16:466
Reifler, Burton V; Bruce, Martha L (2014) Home-based mental health services for older adults: a review of ten model programs. Am J Geriatr Psychiatry 22:241-7
Bao, Yuhua; Eggman, Ashley A; Richardson, Joshua E et al. (2014) Misalignment between medicare policies and depression care in home health care: home health provider perspectives. Psychiatr Serv 65:905-10
Pickett, Yolonda R; Greenberg, Rebecca L; Bazelais, Kisha N et al. (2014) Depression treatment disparities among older minority home healthcare patients. Am J Geriatr Psychiatry 22:519-22

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