Quality of Somatic Care for the Seriously Mentally III

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DESCRIPTION (Provided by applicant): This is a request for an NIMH RCA-K08 to investigate the quality of somatic health care available to people with serious mental illness (SMI). The application calls for an integrated program of research and training designed to inform a long-term programmatic focus on quality of care (QOC) assessment methodology and related translational efforts to improve the delivery of coordinated/integrated medical care for people living with SMI. The proximal focus of the grant highlights hepatitis C (HCV) as an important heuristic tracer condition for understanding somatic comorbidity and issues of availability, access, coordination and utilization of quality medical care more generally among people living with SMI. The research component consists of three projects. The first proposes a naturalistic prospective follow-up of HCV infected adults with SMI. The study aims to compare clinical management practices and benchmarks of care across two different service systems serving adults with SMI. The second study, building on an existing Quality of Care Assessment in Schizophrenia study (Anthony Lehman, P.I.), extends the application of the Medical Expenditure Panel Survey, and AHCPR-sponsored national survey, to the assessment of medical services utilization among a cohort of adults living with schizophrenia and receiving treatment at an outpatient community mental health center. The project also documents the extent of serological testing for HVC and evaluates patient characteristics that correlated with receipt of such testing. The third study, a replication of the previous project in an integrated Veterans Affairs healthcare system, will allow for comparisons across the two service systems. The educational/training component, constructed to interdigitate with and inform the research component will provide advanced training in three general areas: 1) Infectious disease and clinical epidemiology; 2) Quality of care and mental health services research design methodologies; and 3) Translational methodologies and the application of services research to inform practice. The overall goal of the educational/training program is to increase the methodological rigor of the proposed research and to facilitate the ability of the investigator to integrate these domains of research into further projects.