The goal of this proposed Home Care Intervention and Practice Research Infrastructure Program (RISP) is to develop research aimed at improving the treatment and outcomes of depression in elderly patients receiving home health care. The application requests funding for conceptual, methodological, and site development of depression intervention research in geriatric home care. Our group brings the following critical experiences: 1. Generation of social, clinical, and biological findings; 2. Development and application of clinical and public health methodologies; and 3. Transfer of findings and methods into community practice, including primary care and home care. This application is a natural progression from our epidemiologic research which has found a high prevalence of major depression in these patients. Despite the availability of efficacious treatments, the great majority of home care patients receive no treatment for their depression. We plan to implement RISP initiatives in partnership with the three largest home care agencies serving Westchester County, NY. The overall aim will be pursued through three specific initiatives selected to facilitate and accelerate the rate of conceptual growth, methodological sophistication, and agency infrastructure development required for advancing depression research in home care: 1. Collaborate in developing, implementing, and evaluating training aimed at improving the detection of depression; 2. Collaborate to ensure timely access to the agency's patient population and its clinical data for purposes of implementing study designs; 3. Promote research development in home care by: a. Designing and conducting R01-quality intervention research based upon already completed studies, and b. Designing and implementing home care intervention pilots that test the feasibility, acceptability, and potential impact of interventions aimed at improving the treatment and outcomes of depression. Sample interventions include: 1) electronic depression management guidelines; 2) nurse communication skills training; and 3) telephone depression management. Cornell's Home Care RISP comes at a critical juncture in the development of effective interventions for depression in this often ignored sector of the health care system. The RISP is designed to build upon our knowledge and experience in home care research by applying conceptual and methodological advances from related fields. We expect this combination of skills and experience working in partnership with home care agencies will maximize the speed and depth of our capacity to develop depression intervention research in home care and improve patient care and outcomes of depression.
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