The Foundation's initiative, Finding Answers: Disparities Research for Change, was designed to use research and evaluation to test hypothetical solutions for reducing racial and ethnic disparities in health care settings and actual disparity reduction outcomes in ongoing programs.This project addresses the question of how to make quality depression care more accessible for low-income, minority populations. Although quality improvement interventions for depression in primary care settings have proven effective at improving access and quality of depression care, low-income, minority patients disproportionately utilize the emergency department (ED) as a surrogate for primary care and are rarely screened for or provided with depression treatment. For depression care to be effective and sustainable within public-sector EDs, interventions must be developed that are: (1) culturally and linguistically sensitive for minority populations; (2) accommodating patient preferences; (3) attending to the priorities of public-sector ED and hospital administrators; and (4) considering the capacity of public-sector facilities to maintain appropriate levels of depression care. In one of the largest public-sector EDs in the United States serving mostly low-income Latinos, the University of Southern California will assess whether a depression intervention that uses Latino community health workers (promotores) and a study social worker can improve access to depression care. Promotores will screen patients in ED waiting rooms for depression; 100 depressed patients will be randomized to the study intervention vs. a wait list control. Following an education session, intervention patients will be allowed to choose brief psychotherapy with the social worker, antidepressant medication from a psychiatrist, or both. Outcomes will be assessed using quantitative and qualitative methods and will include feasibility (use of depression services, barriers to implementation), acceptability (patient, provider and administrator satisfaction), possible effectiveness (depression severity, quality of life), health services utilization (number of emergency departments, primary care and mental health visits) and cost analysis. Information regarding the impact and sustainability of an intervention to improve depression care for vulnerable ED patients will be gained.
Amount Awarded $250,000.00
Awarded on: 11/22/2006
Time frame: 12/1/2006 - 9/30/2009
Grant Number: 59743