Quality of health care with regard to detection and treatment of mental disorders in patients with coronary heart disease (MenDis-CHD): study protocol.
BACKGROUND
Mental disorders (MD), such as depression, anxiety, and cognitive impairment, are highly prevalent in patients with coronary heart disease (CHD). Current guidelines on cardiovascular diseases recommend screening and appropriate treatment of MD; however, the degree of implementation of such recommendations in clinical practice is unknown. This study aims to analyze the quality of health care of patients with CHD and MD. Specifically, we aim to analyze (1) the quality of care, (2) trajectories of care, and (3) barriers regarding the detection and treatment of MD. Moreover, we want to identify potentials of changes in health care delivery towards more patient-centered care. The results of this study shall be the first step towards value-based care of people with CHD and comorbid mental disorders.


METHODS
We aim to include the following participants: adult patients with CHD (n = 400), their relatives (n = 350) and physicians (n = 80). A particular focus will be on the vulnerable subgroups of patients with CHD and congestive heart failure (left ventricular ejection fraction < 40%) and on the underrepresented group of women with CHD. We will apply a mixed-method approach with a quantitative and a qualitative part. Patient-related outcomes (e.g., health-related quality of life, needs, and preferences regarding health care, reasons for non-detection, and lack of treatment of MD) will be explored in a multi-perspective approach including patients, relatives, and physicians' perspectives. Furthermore, routine data from four statutory health insurance funds (SHI) will be analyzed regarding the frequency and treatment of MD in CHD patients.


DISCUSSION
MenDis-CHD will provide important insights into the trajectories of health care, quality of health care, barriers, patient needs and preferences as well as expectations and satisfaction with health care in patients with CHD and MD. Potential implications of MenDis-CHD are to enable health care providers to redesign care pathways concerning the treatment of mental comorbidity in patients with CHD by proposing value-based changes in health care and by understanding the barriers to and facilitators of change towards patient-centered care.


TRIALS REGISTRATION
German clinical trials register (Deutsches Register Klinischer Studien, DRKS) ieRegistration Number: DRKS00012434, date of registration: May 11th, 2017.
['Peltzer|Samia|S|http://orcid.org/0000-0001-9784-6413', 'Müller|Hendrik|H|', 'Köstler|Ursula|U|', 'Blaschke|Katja|K|', 'Schulz-Nieswandt|Frank|F|', 'Jessen|Frank|F|', 'Albus|Christian|C|', '|||']
D000328:Adult D003327:Coronary Disease D003695:Delivery of Health Care D005260:Female D005858:Germany D006297:Health Services Accessibility D006801:Humans D008297:Male D001523:Mental Disorders D011787:Quality of Health Care D012107:Research Design
Mental disorders Coronary heart disease Cognitive impairment Value-based health care