John A. Hartford Foundation

About: John A. Hartford Foundation is a nonprofit organization based out in New York, New York, United States. It is known for research contribution in the topics: Health care & Gerontological nursing. The organization has 101 authors who have published 119 publications receiving 5431 citations. The organization is also known as: Hartford Foundation.

Collaborative Care Management of Late-Life Depression in the Primary Care Setting: A Randomized Controlled Trial

Abstract: ContextFew depressed older adults receive effective treatment in primary care settings.ObjectiveTo determine the effectiveness of the Improving Mood–Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression.DesignRandomized controlled trial with recruitment from July 1999 to August 2001.SettingEighteen primary care clinics from 8 health care organizations in 5 states.ParticipantsA total of 1801 patients aged 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%).InterventionPatients were randomly assigned to the IMPACT intervention (n = 906) or to usual care (n = 895). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care expert and who offered education, care management, and support of antidepressant management by the patient's primary care physician or a brief psychotherapy for depresssion, Problem Solving Treatment in Primary Care.Main Outcome MeasuresAssessments at baseline and at 3, 6, and 12 months for depression, depression treatments, satisfaction with care, functional impairment, and quality of life.ResultsAt 12 months, 45% of intervention patients had a 50% or greater reduction in depressive symptoms from baseline compared with 19% of usual care participants (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.71-4.38; P<.001). Intervention patients also experienced greater rates of depression treatment (OR, 2.98; 95% CI, 2.34-3.79; P<.001), more satisfaction with depression care (OR, 3.38; 95% CI, 2.66-4.30; P<.001), lower depression severity (range, 0-4; between-group difference, −0.4; 95% CI, −0.46 to −0.33; P<.001), less functional impairment (range, 0-10; between-group difference, −0.91; 95% CI, −1.19 to −0.64; P<.001), and greater quality of life (range, 0-10; between-group difference, 0.56; 95% CI, 0.32-0.79; P<.001) than participants assigned to the usual care group.ConclusionThe IMPACT collaborative care model appears to be feasible and significantly more effective than usual care for depression in a wide range of primary care practices.

Effect of Improving Depression Care on Pain and Functional Outcomes Among Older Adults With Arthritis: A Randomized Controlled Trial

Abstract: ContextDepression and arthritis are disabling and common health problems in late life. Depression is also a risk factor for poor health outcomes among arthritis patients.ObjectiveTo determine whether enhancing care for depression improves pain and functional outcomes in older adults with depression and arthritis.Design, Setting, and ParticipantsPreplanned subgroup analyses of Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), a randomized controlled trial of 1801 depressed older adults (≥60 years), which was performed at 18 primary care clinics from 8 health care organizations in 5 states across the United States from July 1999 to August 2001. A total of 1001 (56%) reported coexisting arthritis at baseline.InterventionAntidepressant medications and/or 6 to 8 sessions of psychotherapy (Problem-Solving Treatment in Primary Care).Main Outcome MeasuresDepression, pain intensity (scale of 0 to 10), interference with daily activities due to arthritis (scale of 0 to 10), general health status, and overall quality-of-life outcomes assessed at baseline, 3, 6, and 12 months.ResultsIn addition to reduction in depressive symptoms, the intervention group compared with the usual care group at 12 months had lower mean (SE) scores for pain intensity (5.62 [0.16] vs 6.15 [0.16]; between-group difference, −0.53; 95% confidence interval [CI], −0.92 to −0.14; P = .009), interference with daily activities due to arthritis (4.40 [0.18] vs 4.99 [0.17]; between-group difference, −0.59; 95% CI, −1.00 to −0.19; P = .004), and interference with daily activities due to pain (2.92 [0.07] vs 3.17 [0.07]; between-group difference, −0.26; 95% CI, −0.41 to −0.10; P = .002). Overall health and quality of life were also enhanced among intervention patients relative to control patients at 12 months.ConclusionsIn a large and diverse population of older adults with arthritis (mostly osteoarthritis) and comorbid depression, benefits of improved depression care extended beyond reduced depressive symptoms and included decreased pain as well as improved functional status and quality of life.

Improving primary care for depression in late life: the design of a multicenter randomized trial.

Abstract: Background.Late life depression can be successfully treated with antidepressant medications or psychotherapy, but few depressed older adults receive effective treatment.Research Design. A randomized controlled trial of a disease management program for late life depression.Subjects.Approximately 1,75

Caring for High-Need, High-Cost Patients—An Urgent Priority

Abstract: Five foundations aim to improve care for high-need, high-cost patients by building U.S. capabilities in three vital areas: clarifying the needs of such patients, elucidating the best ways of caring for them, and assisting with the spread of proven approaches.