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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.

TitleIntegrating 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.
Publication TypeJournal Article
Year of Publication2016
AuthorsBruce ML, Lohman MC, Greenberg RL, Bao Y, Raue PJ
JournalJ Am Geriatr Soc
Volume64
Issue11
Pagination2196-2203
Date Published2016 Nov
ISSN1532-5415
KeywordsAged, Depression, Female, Geriatric Assessment, Home Health Nursing, Hospitalization, Humans, Interview, Psychological, Male, Medicare, Medication Therapy Management, Outcome and Process Assessment (Health Care), Patient Care Planning, Patient Education as Topic, Patient Readmission, Symptom Assessment, Telecommunications, United States
Abstract

OBJECTIVES: To determine whether a depression care management intervention in Medicare home health recipients decreases risk of hospitalization.

DESIGN: Cluster-randomized trial. Nurse teams were randomized to intervention (12 teams) or enhanced usual care (EUC; 9 teams).

SETTING: Six home health agencies from distinct geographic regions. Home health recipients were interviewed at home and over the telephone.

PARTICIPANTS: Individuals aged 65 and older who screened positive for depression on nurse assessments (N = 755) and a subset who consented to interviews (n = 306).

INTERVENTION: The Depression CARE for PATients at Home (CAREPATH) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted telephone conferences with team supervisors every 2 weeks.

MEASUREMENTS: Hospitalization while receiving home health services was assessed using data from the home health record. Hospitalization within 30 days of starting home health, regardless of how long recipients received home health services, was assessed using data from the home care record and research assessments.

RESULTS: The relative hazard of being admitted to the hospital directly from home health was 35% lower within 30 days of starting home health care (hazard ratio (HR) = 0.65, P = .01) and 28% lower within 60 days (HR = 0.72, P = .03) for CAREPATH participants than for participants receiving EUC. In participants referred to home health directly from the hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, P = .001) for CAREPATH participants.

CONCLUSION: Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk in older adults receiving Medicare home health nursing services.

DOI10.1111/jgs.14440
Alternate JournalJ Am Geriatr Soc
PubMed ID27739067
PubMed Central IDPMC5118110
Grant ListR01 MH082425 / MH / NIMH NIH HHS / United States
R01 MH096441 / MH / NIMH NIH HHS / United States
R01 MH104200 / MH / NIMH NIH HHS / United States
T32 MH073553 / MH / NIMH NIH HHS / United States
Category: 
Faculty Publication