Population-Based Psychiatric Intervention--Primary Care

基于人群的精神科干预——初级保健

• 批准号: 7022931
• 负责人: WAYNE J KATON
• 金额: $ 11.67万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-02-17 至 2009-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7022931
• 关键词: anxiety disorders; chronic disease /disorder; clinical research; comorbidity; cost effectiveness; diabetes mellitus; health care model; health care quality; health services research tag; human data; human population study; human subject; longitudinal human study; major depression; managed care; mental health epidemiology; outcomes research; panic disorder; primary care physician; quality of life

DESCRIPTION (provided by applicant): This is a request for a competing renewal for an NIMH Midcareer Investigator Award in Patient-Oriented Research. This grant builds on Dr. Katon's extensive research in developing cost-effective interventions to improve the quality of care and outcomes for patients with major depression and panic disorder within primary care systems, and to improve understanding about the prevalence and impact of depressive and anxiety disorders in patients with comorbid medical disorders such as diabetes. The grant also builds on Dr. Katon's experience over two decades in successfully mentoring junior investigators to become independent researchers, including his 15 years of experience as Director of an NIMH T32 NRSA Primary Care-Psychiatry Fellowship. This K24 will enhance Dr. Katon's expertise in epidemiology, biostatistics, health economics and disease management, which will improve his ability to mentor junior colleagues as well as to carry out the patient-oriented research proposed in his current NIMH R01 and other ongoing and new research proposals. The three specific career goals that will be met by the K24 are: 1) To demonstrate in population-based studies the impact of depressive and anxiety disorders in patients with chronic medical illness. The evidence from the population-based studies will be developed in two ways: a) epidemiologic data showing the cross-sectional and longitudinal effect of depression/anxiety on symptom burden, functioning, quality of life, self-care, medical costs and medical outcomes; and b) intervention studies demonstrating that improved quality of care and outcomes of depression in patients with chronic illness results in decreased symptom burden, improved functioning and quality of life, improved self-care and improved disease outcomes (such as HbA1c) at reasonable costs; 2) To continue to disseminate collaborative models of care by: a) expanding evidence of this model's cost-effectiveness in improving outcomes of elderly, underserved populations, and patients with anxiety disorders; b) expanding the evidence that these models have a significant impact on policy-relevant outcomes such as days off work and cut down days at reasonable medical costs; c) developing a fidelity measure of program implementation of collaborative care that can test which components of collaborative care are most important in improving outcomes; and d) developing evidence-based quality of care guidelines for optimizing depression outcomes for HEDIS performance measures; and 3) To continue to expand Dr. Katon's mentorship of junior investigators involved in mental health services research. These goals will be met through continued and expanded research activities, graduate-level coursework in epidemiology, health services, health management, biostatistics and health economics at the University of Washington School of Public Health and mentorship from external consultants. These courses will improve Dr. Katon's ability as a mentor as well as enhancing the proposed cutting-edge research activities in cost-effectiveness analysis, meta-analysis, measuring indirect costs (work productivity and absenteeism), development of a fidelity measure of collaborative care and an enhanced understanding of organizational and regulatory issues in disseminating collaborative care models. A K24 at this stage of the applicant's career will provide release from administrative responsibilities and provide the time and resources needed to capitalize on an excellent network of senior investigators who will provide mentoring and potential collaborative research opportunities.

描述（由申请人提供）：这是对 NIMH 以患者为导向的研究领域的职业生涯中期研究者奖竞争性续展的请求。 这笔赠款建立在卡顿博士在开发具有成本效益的干预措施方面的广泛研究的基础上，以提高初级保健系统中重度抑郁症和恐慌症患者的护理质量和结果，并增进对抑郁症和焦虑症的患病率和影响的了解患有糖尿病等共病的患者。 这项资助还建立在 Katon 博士二十多年来成功指导初级研究人员成为独立研究人员的经验之上，包括他担任 NIMH T32 NRSA 初级保健精神病学奖学金主任的 15 年经验。 K24 将增强 Katon 博士在流行病学、生物统计学、卫生经济学和疾病管理方面的专业知识，这将提高他指导初级同事的能力，以及开展他当前的 NIMH R01 和其他正在进行的和新的研究中提出的以患者为导向的研究的能力研究建议。 K24 将实现的三个具体职业目标是： 1) 在基于人群的研究中证明抑郁症和焦虑症对慢性疾病患者的影响。 基于人群的研究证据将以两种方式得到：a) 流行病学数据显示抑郁/焦虑对症状负担、功能、生活质量、自我护理、医疗费用和医疗结果的横向和纵向影响; b) 干预研究表明，改善慢性病患者的护理质量和抑郁症结局可减轻症状负担、改善功能和生活质量、改善自我护理并以合理的成本改善疾病结局（如 HbA1c）； 2) 通过以下方式继续传播协作护理模式： a) 扩大该模式在改善老年人、服务不足人群和焦虑症患者预后方面的成本效益证据； b) 扩大证据表明这些模型对政策相关结果具有重大影响，例如休假天数和以合理医疗费用减少天数； c) 制定协作护理计划实施的保真度衡量标准，可以测试协作护理的哪些组成部分对于改善结果最重要； d) 制定基于证据的护理质量指南，以优化 HEDIS 绩效衡量的抑郁结果； 3) 继续扩大 Katon 博士对参与心理健康服务研究的初级研究人员的指导。 这些目标将通过华盛顿大学公共卫生学院持续和扩大的研究活动、流行病学、卫生服务、健康管理、生物统计学和卫生经济学的研究生课程以及外部顾问的指导来实现。 这些课程将提高卡顿博士作为导师的能力，并加强在成本效益分析、荟萃分析、衡量间接成本（工作生产力和缺勤）、制定协作护理保真度措施方面拟议的尖端研究活动加深对传播协作护理模式中的组织和监管问题的理解。 在申请人职业生涯的这一阶段，K24 将使申请人摆脱行政责任，并提供利用高级研究人员的优秀网络所需的时间和资源，这些研究人员将提供指导和潜在的合作研究机会。