HEALTH STATUS AND SERVICE USE IN CORONARY DISEASE

在接下来的几十年里，医学将面临一项新的首要任务：最大化 慢性病患者的功能和生活质量。一种新的 集预防与康复于一体的“人口医学” 治疗性干预措施已经在#年形成。 管理型医疗设置。这为创新提供了一个独特的机会 在生物医学和心理社会保健服务的整合方面。这 科学家发展奖将使我做好准备，帮助领导精神病学 为这一创新做出了贡献。 拟议的课程工作、研讨会和督导的五年学习计划 流行病学和卫生服务方面的研究将允许我从 从对照临床研究到基于人群的研究。三项研究 建议对冠心病的健康状况和服务使用情况进行评估。 首先，对患者的功能状态进行纵向、观察性研究 和冠状动脉插管术后的生活质量。232名患者 已经进行了广泛的基线生物医学和心理社会评估 一年的随访期。这笔赠款将允许5年和7年的评估 在导尿术和扩大结果措施以包括更多 与健康相关的生活质量领域。 第二，抑郁在心脏疾病中作用的实验研究 功能、功能状态和生活质量作为 舍曲林随机对照试验治疗新近发现的 心肌梗死和重度抑郁症。80例心肌梗塞后抑郁患者 将随机服用安慰剂或舍曲林，为期12周。这些病人 50名非抑郁的心肌梗死后患者将接受为期一年的随访 进食时对功能状态和生活质量的广泛评估 12周、24周和52周。 第三，参与数据分析的三个荷兰人系列 150例老年人功能状态和生活质量的队列研究 每个患者都会出现抑郁、心力衰竭和 心肌梗死。这些队列研究跟踪参与者从一个交叉- 对5000名随后选择的专业进行实验的横断面研究 事件。事件案例在四周、三周和八周进行面谈 在指数事件之后的几个月。 这些研究提供了纵向、实验性和队列研究的机会。 设计作为一种提供了解生物医学与 功能状态和生活质量的心理社会原因。

In the coming decades, medicine will face a new primary task: maximizing function and quality of life for those wit chronic disease. A new "population-based medicine" which integrates preventive and rehabilitative interventions with curative interventions is already taking shape in managed care settings. This provides a unique opportunity for innovation in the integration of biomedical and psychosocial health services. This Scientist Development Award will prepare me to help lead psychiatry as it contributes to this innovation. The proposed 5-year plan of study of course work, seminars, and supervised research in epidemiology and health services will permit me to switch from controlled clinical research to population-based research. Three studies of health status and service use in coronary artery disease are proposed. FIRST, a longitudinal, observational study of patients' functional status and quality of life following coronary catheterization. 232 patients have already had extensive baseline biomedical and psychosocial assessments and one year of follow-up. This grant will allow assessments at 5 and 7 years after catheterization and an expansion of outcome measures to include more domains of health-related quality of life. SECOND, an experimental study of the role of depression in cardiac function, functional status, and quality of life conducted as part of a randomized controlled trial of sertraline in patients with a recent myocardial infarction and major depression. 80 depressed post-MI patients will be randomized to placebo or sertraline for 12 weeks. These patients and 50 non-depressed post-MI patients will be followed for a year with extensive assessments of functional status and quality of life at intake 12, 24, and 52 weeks. THIRD, participation in the data analysis in a series of three Dutch cohort studies following the functional status and quality of life of 150 patients each following development of depression, heart failure, and myocardial infarction. These cohort studies track enrollees from a cross- sectional study of 5000 who subsequently experiment a selected major event. The incident cases are interviewed at four weeks, three and eight months after the index event. These studies provide exposure to longitudinal, experimental, and cohort designs as ways of providing training in understanding biomedical vs psychosocial causation of functional status and quality of life.