Clinical Effectiveness of Integrating Depression Care Management Into Medicare Home Health

Abstract

IMPORTANCE Among older home health care patients, depression is highly prevalent, is often inadequately treated, and contributes to hospitalization and other poor outcomes. Feasible and effective interventions are needed to reduce this burden of depression.OBJECTIVE To determine whether, among older Medicare Home Health recipients who screen positive for depression, patients of nurses receiving randomization to an intervention have greater improvement in depressive symptoms during 1 year than patients receiving enhanced usual care. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized effectiveness trial conducted at 6 home health care agencies nationwide assigned nurse teams to an intervention (12 teams) or to enhanced usual care (9 teams). Between January 13, 2009, and December 6, 2012, Medicare Home Health patients 65 years and older who screened positive for depression on routine nursing assessments were recruited, underwent assessment, and were followed up at 3, 6, and 12 months by research staff blinded to intervention status. Patients were interviewed at home and by telephone. Of 502 eligible patients, 306 enrolled in the study. INTERVENTIONS The Depression Care for Patients at Home (Depression CAREPATH) trial requires nurses to manage depression at routine home visits by weekly symptom assessment, medication management, care coordination, education, and goal setting. Nurses' training totaled 7 hours (4 onsite and 3 via the web). Researchers telephoned intervention team supervisors every other week. MAIN OUTCOMES AND MEASURES Depression severity, assessed by the 24-item Hamilton Scale for Depression (HAM-D). RESULTSThe 306 participants were predominantly female (69.6%), were racially/ethnically diverse (18.0% black and 16.0% Hispanic), and had a mean (SD) age of 76.5 (8.0) years. In the full sample, the intervention had no effect (P = .13 for intervention × time interaction). Adjusted HAM-D scores (Depression CAREPATH vs control) did not differ at 3 months (10.5 vs 11.4, P = .26) or at 6 months (9.3 vs 10.5, P = .12) but reached significance at 12 months (8.7 vs 10.6, P = .05). In the subsample with mild depression (HAM-D score, <10), the intervention had no effect (P = .90), and HAM-D scores did not differ at any follow-up points. Among 208 participants with a HAM-D score of 10 or higher, the Depression CAREPATH demonstrated effectiveness (P = .02), with lower HAM-D scores at 3 months (14.1 vs 16.1, P = .04), at 6 months (12.0 vs 14.7, P = .02), and at 12 months (11.8 vs 15.7, P = .005). CONCLUSION AND RELEVANCEHome health care nurses can effectively integrate depression care management into routine practice. However, the clinical benefit seems to be limited to patients with moderate to severe depression. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01979302

Transforming Home Health Nursing with Telehealth Technology

“…Depression severity did not differ at 3 months or 6 months in the Depression CAREPATH and control groups. 13 The 12-month measurement did demonstrate effectiveness in the Depression CAREPATH group. The researchers concluded that home health nurses can effectively integrate depression into routine practice and can clinically benefit patients with moderate to severe depression.…”

“…Depression severity was assessed using the Hamilton Scale for Depression for 306 participants. 13 Home health nursing teams at 6 nationwide home health care agencies were randomly assigned to participants who would also receive the intervention of the Depression CAREPATH and participants who would not receive the intervention. 13 Nurse teams assigned to the depression intervention were trained to manage depression during routine home visits by conducting symptom assessment, medication management, care coordination, education, and goal setting.…”

“…13 Home health nursing teams at 6 nationwide home health care agencies were randomly assigned to participants who would also receive the intervention of the Depression CAREPATH and participants who would not receive the intervention. 13 Nurse teams assigned to the depression intervention were trained to manage depression during routine home visits by conducting symptom assessment, medication management, care coordination, education, and goal setting. 13 Follow-up of patients was conducted at 3 months, 6 months, and 12 months for depression symptoms by research staff blinded to who was in the intervention group.…”

“…13 Nurse teams assigned to the depression intervention were trained to manage depression during routine home visits by conducting symptom assessment, medication management, care coordination, education, and goal setting. 13 Follow-up of patients was conducted at 3 months, 6 months, and 12 months for depression symptoms by research staff blinded to who was in the intervention group. Participants were interviewed at home and by telephone.…”

Caring for Depression in Older Home Health Patients

“…The effectiveness of the Depression CAREPATH in reducing depressive symptoms in Medicare Home Health patients has been demonstrated in a randomized trial conducted in six, geographically distinct home health agencies (Bruce et al, 2015). The study randomized teams of nurses to intervention or enhanced usual care.…”