Personalized Response through Integrated Measurement for Depression in Primary care (PRIME-DEP-PC) for Older Adults with Multimorbidity
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Depression in older adults with multimorbidity (MM) is common, and largely treated by primary care providers with limited rates of treatment response and symptom remission. The limited effectiveness of depression treatment in this population is partly due to low rates of measurement-based care (the systematic use of standardized measured to support treatment decisions), poor quality data on depression symptoms due to recall bias at follow up appointments, and the heterogeneity of both depression and multimorbidity. The central hypothesis of this K23 proposal is that ecological momentary assessment (EMA) can address the limitations of existing approaches to depression management and strengthen the potency of existing management approaches for depressed older adults with MM by personalizing treatment based on unique symptom patterns and trajectories. Therefore, I aim to develop a “Personalized Response through Integrated Measurement of Depression in Primary Care” (PRIME-DEP-PC): an EMA-based dashboard that automatically creates EMA- derived feedback reports for patients and providers to enhance depression management in primary care. Building on my prior work on older adults with MM and the training plan in this K23, I propose an innovative approach to personalized care, capitalizing on EMA to increase treatment effectiveness for depressed older adults with MM in primary care through a user-centered design process. In Aim 1, I will leverage preliminary data to refine and adapt PRIME-DEP-PC into a standalone dashboard, and conduct semi-structured interviews with patients and providers to refine the initial prototype. In Aim 2, I will conduct heuristic analysis and usability testing of the refined PRIME-DEP-PC prototype with patients and their providers. Findings will lead to a refined version of the prototype to be tested in a pilot randomized controlled trial in Aim 3, comparing PRIME-DEP-PC with usual care to examine feasibility and acceptability of the intervention in older adults with MM and their primary care providers. To achieve these aims, I aim to develop my skills in 1) user-centered design, 2) advanced EMA methods and analysis, 3) geriatric clinical trials, and 4) develop the leadership and grant writing skills necessary to direct a research lab. The facilities, sponsoring department, and resources at Weill Cornell Medicine are an exceptional environment for this career development award and for an early career investigator. Additionally, I have assembled an excellent team of experienced mentors (Drs. Reid, Kiosses, Czaja and Rodebaugh). As a clinical health psychologist working at the intersection of chronic illness, mental health, and aging, this award will help me achieve my long-term career goal of being a leading independent clinician-scientist with an impactful program of research focused on reducing the burden of depression in older adults with MM.
