MODELING TREATMENT USE & EFFECTIVENESS IN MENTAL ILLNESS

描述(申请者摘要)：此申请寻求对团队的支持 统计学家、经济学家、临床医生和心理健康服务 研究人员将就离散技术的开发和应用进行合作 用于理解治疗用法和因果推断的选择模型 精神疾病的实验和自然主义研究。通过研究如何 患者与现有系统中的治疗相匹配，研究人员将获得 更深入地了解医疗质量的决定因素。具体目标 将涉及1)基于可能性的方法的扩展以估计治疗 在实际收到的水平上的有效性，使用来自两个 有影响力的临床试验(Schulberg、Block、Madonia等人，Acrh Gen 精神病学1996；53：913-9&罗森海克，尼尔，Arch Gen精神病学 1998年；55：459-66)，并将这些估计数与根据常规 方法，如意向治疗、适当原则和完全者原则，2) 解释治疗变异的离散选择新模型的发展 根据患者、提供商和保险的特点私下使用 参保和医疗补助受益人，以及3)这些离散选择的应用 解释遵循治疗建议的差异和 对抑郁症和精神分裂症的治疗效果 练习设置数组。由以下领导人组成的咨询委员会 统计学、经济学和精神病学将每年召开会议，以验证方法 并确保将技术融入精神卫生服务研究。这个 这项研究的方法进步将使心理健康 研究人员和政策制定者更好地描述常规护理并扩大 从临床试验中得出的结论。

DESCRIPTION (Applicant's abstract): This application seeks support for a team of statisticians, economists, clinicians, and mental health services researchers to collaborate on the development and application of discrete choice models for understanding treatment use and for causal inferences in experimental and naturalistic studies of mental illness. By studying how patients are matched with treatments in extant systems, researchers will gain greater insight into the determinants of quality of care. The Specific Aims will involve the 1) extension of likelihood-based methods to estimate treatment effectiveness at the levels actually received using experimental data from two influential clinical trials (Schulberg, Block, Madonia et al., Acrh Gen Psychiatry 1996;53:913-9 & Rosenheck, Neale, Arch Gen Psychiatry 1998;55:459-66) and to compare these estimates with those based on conventional approaches, such as intention-to-treat, adequate, and completer principles, 2) development of new models of discrete choice to explain variation in treatment use based on patient, provider, and insurance characteristics for privately insured and Medicaid beneficiaries, and 3) application of these discrete choice models to explain variation in adherence with treatment recommendations and in treatment effectiveness for depression and for schizophrenia across a diverse array of practice settings. An Advisory Board comprised of leaders in statistics, economics, and psychiatry will convene annually to validate methods and ensure integration of techniques into mental health services research. The methodological advances from this research will enable mental health researchers and policy makers to better characterize usual care and to expand the inferences drawn from clinical trials.