CORE--SERVICE INNOVATIONS

核心——服务创新

• 批准号: 6650638
• 负责人: ELIZABETH A BOYD
• 金额: $ 17.24万
• 依托单位: RUTGERS, THE STATE UNIV OF N.J.
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-01 至 2003-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6650638
• 关键词: antipsychotic agents; behavioral /social science research tag; biomedical facility; caregivers; clinical research; clinical trials; cognitive behavior therapy; community mental health services; family structure /dynamics; health care policy; health care service utilization; health services research tag; human subject; human therapy evaluation; interview; managed care; mental disorder chemotherapy; motivation; outcomes research; patient care management; quality of life; relapse /recurrence; schizophrenia; telecommunications; therapy compliance

Description: The Center has embarked on a systematic study of the changing mental health system. This core supports that effort along several dimensions through four projects that focus on the "meso" and direct service level of mental health services delivery. These levels address the implementation of disease management programs, the organization and management of patient care teams, and the rules for triage and eligibility for specialized services. This focus is seen as necessary, according to the researchers, due to the challenge of adapting the results of efficacy studies to real conditions under which mental health services are provided, and to improve the effectiveness of managed care strategies, and incentives. The studies follow a trajectory of methodologies that began with descriptive studies, followed by multivariate prospective studies to more complex randomized controlled trials. The subject of the proposed work is patient compliance, specifically medication compliance in different service settings. They propose to examine strengthening client/family interactions through building bonds of reciprocity; tracking portions of the mental health delivery systems through collaboration on the Health Care for Communities (HCC) survey and through state surveys of residential facilities. For Project 1A (p 306), it is proposed that compliance behavior be controlled for when evaluating experimental-control group differences in clinical and social outcomes at 6 and 12 weeks. It is presumed that compliance here means compliance with the compliance therapy. In any case, the investigators should be more specific about how they propose to adjust for compliance behavior given the pitfalls of adjusting for observed compliance when analyzing differences between randomized groups. Given the investigators? knowledge of instrumental variables, it is likely that they understand the use of this approach to adjust for non-compliance with the compliance therapy. Also for Project 1A (p 306), a cost analyses is proposed without specifics. The analysis plans for Projects 2 and 3 (p. 308-309, 311-312) are too general, especially given that analyses are planned in the first year of the grant (p. 317). The pilot data analysis proposed for Project 4 (page 315-316) appears to run the risk of possible non-compliance problems with the INCube program. An instrumental variable analysis may be appropriate here.

描述：该中心已开始对不断变化的情况进行系统研究 心理健康系统。该核心从多个维度支持这一努力 通过四个重点关注“中观”和直接服务水平的项目 提供心理健康服务。这些级别涉及实施 疾病管理计划、患者护理的组织和管理 团队，以及专业服务的分类和资格规则。这 研究人员表示，由于面临的挑战，集中注意力被认为是必要的 使功效研究的结果适应实际条件 提供心理健康服务，并提高其有效性 管理式医疗策略和激励措施。研究遵循以下轨迹 从描述性研究开始，然后是多元研究的方法 前瞻性研究到更复杂的随机对照试验。主题 拟议工作的一部分是患者依从性，特别是药物依从性 在不同的服务设置中。他们建议研究加强 通过建立互惠纽带与客户/家人互动；追踪 通过合作，精神卫生服务系统的一部分 社区医疗保健 (HCC) 调查和州调查 住宅设施。 对于项目 1A（第 306 页），建议控制合规行为 用于评估实验对照组在临床和临床方面的差异 6 周和 12 周时的社会结果。这里假设合规意味着 遵守依从性治疗。无论如何，调查人员应该 更具体地说明他们建议如何调整合规行为 分析差异时调整观察到的合规性的陷阱 随机组之间。考虑到调查人员？器乐知识 变量，很可能他们了解使用这种方法来调整 不遵守依从性治疗。 同样对于项目 1A（第 306 页），提出了成本分析，但没有具体说明。 项目 2 和 3（第 308-309、311-312 页）的分析计划太笼统， 特别是考虑到分析计划在赠款的第一年进行（第 17 页）。 317）。 为项目 4（第 315-316 页）提议的试点数据分析似乎正在运行 INCube 计划可能出现不合规问题的风险。一个 工具变量分析在这里可能是合适的。