HEALTH STATUS AND SERVICE USE IN CORONARY DISEASE

在未来几十年，医学将面临一个新的首要任务：最大限度地 功能和生活质量为那些wit慢性病。 一个新 结合预防和康复的“人口医学” 治疗性干预措施已经在形成， 管理式护理环境。 这为创新提供了独特的机会 在生物医学和心理社会健康服务的整合方面。这 科学家发展奖将使我准备帮助领导精神病学， 有助于这一创新。 拟议的5年计划的研究课程的工作，研讨会，并监督 流行病学和卫生服务方面的研究将使我能够从 对照临床研究到基于人群的研究。 三项研究 的健康状况和服务使用的冠状动脉疾病。 FIRST，对患者功能状态的纵向观察性研究 和冠状动脉导管插入术后的生活质量。 232例患者 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。 这笔赠款将允许在5年和7年进行评估 在导管插入术和扩展结果测量后， 健康相关生活质量领域。 第二，抑郁症对心脏功能影响的实验研究 功能、功能状态和生活质量， 舍曲林治疗近期心血管疾病的随机对照试验 心肌梗死和重度抑郁症 80例MI后抑郁患者 将被随机分配至安慰剂组或舍曲林组，持续12周。 这些患者 和50名非抑郁的心肌梗死后患者将被随访一年， 在摄入时对功能状态和生活质量进行广泛评估 12、24、52周。 第三，参与数据分析的三个荷兰系列 随访150例功能状态和生活质量的队列研究 患者在抑郁症、心力衰竭和 心肌梗死 这些队列研究跟踪了来自交叉的注册者- 对5000人进行的部分研究，他们随后对选定的专业进行了实验 活动 事件案例在四周、三周和八周进行访谈 指数事件发生后的几个月。 这些研究提供了纵向、实验性和队列的暴露。 设计作为提供培训的方式，了解生物医学与 功能状态和生活质量的社会心理原因。

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.