Project Summary

PCORI funds implementation projects to increase awareness and promote the use of PCORI-funded research findings to improve health care practices and health outcomes. This project is proposing to conduct implementation activities for the results of the completed PCORI-funded study titled "Comparing Two Treatments for Depression among Patients with Kidney Failure Receiving Hemodialysis -- The ASCEND Study" across an entire dialysis organization, Satellite Healthcare.

This PCORI-funded implementation project is putting a program in place to screen for and manage depression for patients on dialysis.

In patients with kidney disease, the kidneys don’t work well to remove waste from the blood. Some people with kidney disease have kidney failure and have lost most of their kidney function. These patients often receive dialysis, a treatment with a machine that cleans the blood.

What is the goal of this implementation project?

Depression is common in patients with kidney failure who are on dialysis. Medicine and cognitive behavioral therapy, or CBT, are common ways to treat depression. In CBT, patients learn to change patterns in their thinking to improve how they feel. A PCORI-funded research study found that CBT and a medicine called sertraline worked about the same to reduce symptoms of depression in patients on dialysis. 

This project is putting a program in place in dialysis units to screen for and treat depression in patients on dialysis. 

What will this project do?

The project team is putting the program in place at 83 dialysis units in California, New Jersey, Tennessee, and Texas. These units are part of a single dialysis organization. They serve diverse patients, including those who have Medicaid or limited incomes and patients who identify as Hispanic.

In the program, dialysis social workers screen patients for symptoms of depression and assess patients identified through screening. Patients with depression then receive information to help them choose a treatment—either medicine or CBT. Units are offering CBT via telehealth. Telehealth is a way to provide care to patients remotely using phone or video to help manage care.

The project team is working with dialysis units to: 

  • Create materials for patients in English and Spanish that include results from the PCORI study, explain treatment options for depression, and support shared decision making between patients and clinicians
  • Train social workers to take on new roles to support CBT across the dialysis organization
  • Adapt an electronic health record, or EHR, system to support the screening and treatment program
  • Train unit staff, including social workers, medical directors, and clinicians
  • Identify champions to promote the program and support staff training at each unit and the organization

What is the expected impact of this project?

This project will demonstrate what’s required to put a depression screening and treatment program in place at dialysis units. Through this program, more than 8,000 patients will receive screening for depression. More than 650 staff, including social workers, medical directors, and clinicians, will receive training. The project evaluation will confirm that the program is working as intended to improve depression screening and treatment and quality of life for patients on dialysis. 

More about this implementation project:

Stakeholders Involved in This Project

  • American Association of Kidney Patients (AAKP)

  • Council of Nephrology Social Workers of the National Kidney Foundation

  • American Nephrology Nurses Association

Implementation Strategies

  • Promote shared decision making.

  • Integrate an EHR module to facilitate screening and treatment for depression.

  • Develop patient education materials to facilitate shared decision making.

  • Use a phased implementation approach.

  • Engage site champions.

  • Develop unit-level implementation bundles to help train clinicians and site champions.

Evaluation Outcomes

To document implementation:

  • Proportion of eligible patients screened and evaluated for depression

  • Treatment acceptance and treatment choice

  • Time from diagnosis of depression to treatment

  • Fidelity to implementation strategy 

To assess healthcare and health outcomes:

  • Depression symptoms at three months

  • Quality of life

Project Information

Rajnish Mehrotra, M.D., M.S.
University of Washington
$2,129,704
Implementing Treatments for Depression for Patients Undergoing Long-Term Dialysis

Key Dates

June 2023
January 2027
2023

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Comparing Two Treatments for Depression among Patients with Kidney Failure Receiving Hemodialysis -- The ASCEND Study

Tags

State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 28, 2024