Depression
Conditions
Keywords
Rehospitalization, Reutilization, Depressive Symptoms, Pharmacotherapy, Cognitive Therapy, Self-help, Complementary Therapies
Brief summary
Project Re-Engineered Discharge (Project RED) has previously demonstrated that patients who received the RED were 30% less likely than patients receiving usual care to access inpatient or emergency services within 30 days of discharge. In this project, the investigators add a new dimension to RED by integrating screening, referral and treatment for depression into the original RED intervention and determining if this enhanced intervention increases the effectiveness of RED in preventing readmissions and controlling costs in the 180 days after discharge for patients with signs of depression.
Interventions
OTHERRED-D Care Management
The Case Management intervention will continue for 12 weeks post-discharge (from the index admission).
Sponsors
Agency for Healthcare Research and Quality (AHRQ)
Boston Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Over 18 years of age * Admitted to any Boston Medical Center inpatient service or for observation * Screen positive for depressive symptoms (Patient Health Questionnaire - 2 \>/= 3) * Speaks English with health care providers * Has access to a telephone * Live in the Boston area and don't plan on leaving the Boston area for more than 2 weeks in the next 6 months * Screen positive for depressive symptoms (PHQ -9 \>/= 10)
Exclusion criteria
* Has plans for inpatient rehabilitation, nursing home, or other institutional settings after discharge. * Suicidal precautions * Sickle Cell Crisis (SCC) * Alcohol and/or drug dependence * Diagnosis of Bipolar Disorder, Schizophrenia or other Psychotic Disorder * In police custody
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| All-cause readmission rates | 30 days and 90 days post-discharge from hospital at index admission | The primary hypothesis is to test whether the RED intervention plus the collaborative-care approach for depression (RED-D) will reduce the all-cause 30 and 90 day hospital readmission rates for patients who screen positive for depressive symptoms |
| All-cause reutilization rates | 30 & 90 days post discharge from index hospitalization | The primary hypothesis is to test whether the RED intervention plus the collaborative-care approach for depression (RED-D) will reduce the all-cause 30 and 90 day hospital utilization rates for patients who screen positive for depressive symptoms |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| cost-saving | 90 & 180 after discharge from index hospitalization | The economic analysis will investigate whether the two interventions are cost saving and whether the RED-D intervention is more cost saving than the RED intervention alone. The principal source of the savings is likely to be from reduced rehospitalizations within the 90 days of study follow-up. Hospital administrative records and insurance company data will be used to gather cost data. Additional costs of the two interventions will be estimated by costing staff time and other resources used. Cost-savings will be estimated by t-test comparisons of the mean costs for the groups; given randomization of patient assignment these will provide unbiased estimates. |
| Mental Health Related Quality of Life | 30 days and 90 days after discharge from index admission | The impact of the RED-D Collaborative Care Intervention mental health related quality of life will be ascertained using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and Work and Social Adjustment Scale (WSAS) . The investigators will test whether collaborative care for depression can produce a clinically meaningful improvement in mental health related quality of life compared to those patients receiving either usual care or the RED discharge alone. |
Countries
United States
Outcome results
None listed