Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, United States; RAND Corporation, United States.
School of Social Work, University of Southern California, United States.
Contemp Clin Trials. 2014 Mar;37(2):342-54. doi: 10.1016/j.cct.2013.11.002. Epub 2013 Nov 8.
Health disparities in minority populations are well recognized. Hispanics and Latinos constitute the largest ethnic minority group in the United States; a significant proportion receives their care via a safety net. The prevalence of diabetes mellitus and comorbid depression is high among this group, but the uptake of evidence-based collaborative depression care management has been suboptimal. The study design and baseline characteristics of the enrolled sample in the Diabetes-Depression Care-management Adoption Trial (DCAT) establishes a quasi-experimental comparative effectiveness research clinical trial aimed at accelerating the adoption of collaborative depression care in safety net clinics. The study was conducted in collaboration with the Los Angeles County Department of Health Services at eight county-operated clinics. DCAT has enrolled 1406 low-income, predominantly Hispanic/Latino patients with diabetes to test a translational model of depression care management. This three-group study compares usual care with a collaborative care team support model and a technology-facilitated depression care model that provides automated telephonic depression screening and monitoring tailored to patient conditions and preferences. Call results are integrated into a diabetes disease management registry that delivers provider notifications, generates tasks, and issues critical alerts. All subjects receive comprehensive assessments at baseline, 6, 12, and 18 months by independent English-Spanish bilingual interviewers. Study outcomes include depression outcomes, treatment adherence, satisfaction, acceptance of assessment and monitoring technology, social and economic stress reduction, diabetes self-care management, health care utilization, and care management model cost and cost-effectiveness comparisons. DCAT's goal is to optimize depression screening, treatment, follow-up, outcomes, and cost savings to reduce health disparities.
少数民族群体中的健康差距是众所周知的。西班牙裔和拉丁裔是美国最大的少数族裔群体；其中相当一部分人通过安全网获得医疗服务。这一群体中糖尿病和合并抑郁症的患病率很高，但采用循证合作性抑郁症护理管理的比例一直不理想。糖尿病-抑郁症护理管理采用试验（DCAT）的研究设计和入组样本的基线特征建立了一项准实验性比较有效性研究临床试验，旨在加速安全网诊所中合作性抑郁症护理的采用。该研究与洛杉矶县卫生服务部合作，在 8 个县运营的诊所进行。DCAT 已经招募了 1406 名低收入、主要为西班牙裔/拉丁裔的糖尿病患者，以测试一种转化模式的抑郁症护理管理。这项三组研究比较了常规护理与合作护理团队支持模式和技术辅助的抑郁症护理模式，后者提供针对患者病情和偏好定制的自动电话抑郁症筛查和监测。呼叫结果被整合到糖尿病疾病管理登记系统中，为提供者提供通知、生成任务和发出关键警报。所有受试者在基线、6、12 和 18 个月时都由独立的英语-西班牙语双语访谈者进行全面评估。研究结果包括抑郁症结果、治疗依从性、满意度、对评估和监测技术的接受程度、社会和经济压力减轻、糖尿病自我护理管理、医疗保健利用以及护理管理模式的成本和成本效益比较。DCAT 的目标是优化抑郁症筛查、治疗、随访、结果和成本节约，以减少健康差距。
