RELATIONSHIPS BETWEEN GEN MED & MENTAL HLTH SPECIALTY

本项目将开发一个综合模型的选择

This project will develop a synthetic model of the selection of patients with psychiatric disorders into general medical and specialty mental health care and examine the content of care in varying outpatient and inpatient settings using data from major national studies )ECA, Rand Health Insurance Experiment, Marshfield Epidemiological Survey, National Ambulatory Medical Care Survey) and State data sets on inpatient care. Before embarking on a new generation of expensive studies on need for care, selection into treatment, and the content of care, thorough efforts will be made to use existing data to develop a predictive selection model, and test and refine it across varying studies. The proposed selection model is based on the assumption that concepts of need should not be based on illness prevalence alone, but also on subjective distress, levels of disability and impairment, and consequences of symptoms for risk and burden. We also believe that social and cultural constraints must be taken into account in understanding responses to need. We propose a selection model based on eight classes of indicators: (1) DIS/DSM-III deagnosis or other measures of psychological disturbance; (2) severity of distress; (3) degree of risk as in violence, explosive behavior or suicide threat; (4) physical co-morbidity; (5) disruptive effects of the illness on work and family; (6) psychological propensities toward psychological and /or specialty mental health care; (7) characteristics of the medical care system including financial access and specialty sector resources available; and (8) cultural characteristics of the geographic area. By conducting parallel analyses across varying data sets using different operational definitions we plan to identify robust and more uncertain patterns. The proposed model, we believe, will not only assist in assissing need and planning services but should be helpful in explaining differences in resource consumption among seemingly comparable patients.