title: 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.
abstract: To determine whether a depression care management intervention in Medicare home health recipients decreases risk of hospitalization.
  
  
  
  Cluster-randomized trial. Nurse teams were randomized to intervention (12 teams) or enhanced usual care (EUC; 9 teams).
  
  
  
  Six home health agencies from distinct geographic regions. Home health recipients were interviewed at home and over the telephone.
  
  
  
  Individuals aged 65 and older who screened positive for depression on nurse assessments (N = 755) and a subset who consented to interviews (n = 306).
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk in older adults receiving Medicare home health nursing services.
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.|Department of Psychiatry, Weill Cornell Medical College, New York City, New York.
authors.forename: Martha L
authors.initials: ML
authors.lastname: Bruce
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, New York City, New York.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Lohman
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, New York City, New York.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Greenberg
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, New York City, New York.|Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Bao
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, New York City, New York.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Raue
mesh_terms: D000368:Aged; D003863:Depression / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D064650:Home Health Nursing / Q000379:methods / Q000458:organization & administration; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007406:Interview, Psychological / Q000379:methods*; D008297:Male; D006278:Medicare; D054539:Medication Therapy Management; D010043:Outcome and Process Assessment, Health Care; D010347:Patient Care Planning; D010353:Patient Education as Topic / Q000379:methods; D010359:Patient Readmission / Q000706:statistics & numerical data*; D063189:Symptom Assessment / Q000379:methods; D013685:Telecommunications / Q000458:organization & administration; D014481:United States
keywords: care management; depression; home health; hospitalization