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.
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