Technology-facilitated depression care management among predominantly Latino diabetes patients within a public safety net care system: comparative effectiveness trial design.
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.
Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, United States; RAND Corporation, United States. Electronic address: shinyiwu@usc.edu.
Shinyi
S
Wu
School of Social Work, University of Southern California, United States. Electronic address: ell@usc.edu.
Kathleen
K
Ell
Los Angeles County Department of Health Services, United States. Electronic address: sschulman@dhs.lacounty.gov.
Sandra G
SG
Gross-Schulman
Los Angeles County Department of Health Services, United States. Electronic address: lsklaroff@dhs.lacounty.gov.
Laura Myerchin
LM
Sklaroff
Department of Psychiatry and Behavioral Sciences, University of Washington, United States. Electronic address: wkaton@u.washington.edu.
Wayne J
WJ
Katon
Drexel University College of Arts and Sciences, United States. Electronic address: Arthur.M.Nezu@drexel.edu.
Art M
AM
Nezu
School of Social Work, University of Southern California, United States. Electronic address: peylee@usc.edu.
Pey-Jiuan
PJ
Lee
Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, United States. Electronic address: irenevidyanti@gmail.com.
Irene
I
Vidyanti
Keck School of Medicine, Department of Preventive Medicine, University of Southern California, United States. Electronic address: cchou@usc.edu.
Chih-Ping
CP
Chou
Los Angeles County Department of Health Services, United States; David Geffen School of Medicine at UCLA, United States. Electronic address: jguterman@dhs.lacounty.gov.
Jeffrey J
JJ
Guterman
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D001521:Behavior Therapy / Q000379:methods; D015897:Comorbidity; D057186:Comparative Effectiveness Research; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000208:ethnology* / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology*; D019468:Disease Management; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006630:Hispanic or Latino; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D010349:Patient Compliance; D017060:Patient Satisfaction; D012107:Research Design; D064876:Safety-net Providers / Q000458:organization & administration; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000517:prevention & control / Q000628:therapy
D000928:Antidepressive Agents
Care management model; Depression; Health technology applications; Hispanic/Latino; Safety net; Type 2 diabetes