Economic Analysis of Depression Treatment Process

抑郁症治疗过程的经济分析

• 批准号: 6793547
• 负责人: MING TAI-SEALE
• 金额: $ 14.89万
• 依托单位: TEXAS A&M UNIVERSITY HEALTH SCIENCE CTR
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-01 至 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6793547
• 关键词: adult human (21+); audiotape; behavior test; behavioral /social science research tag; clinical research; communication; decision making; depression; health care cost /financing; health care quality; health economics; managed care; mathematical model; mental health services; patient care management; patient care personnel relations; population survey; postdoctoral investigator; primary care physician

DESCRIPTION (provided by applicant): Large randomized clinical trials on quality improvement initiatives have produced modest or temporary effects on improving depression care in primary care. Accordingly, there are increased calls for services researchers to question and challenge the approaches used to improve the quality of care for people with mental illnesses. While economic incentives have long been documented to affect physicians' behavior, scant attention has been paid to the alignment of payment incentives with quality improvement. The candidate proposes to integrate the theories and methods from economics and communications research to address how to align payment incentives with quality improvement in the daily practice of mental health treatment in primary care. The applicant requests 5 years of funding through the K01 program to carry out an intensive supervised training and research program including direct observation of mental health treatment in a wide range of clinical settings plus additional training in decision theory and communications research. The training program aims to enhance understanding of how various dynamic professional and economic factors affect physicians' decision-making. The research program will develop a heuristic dynamic economic model of physicians' decision-making and test it with two conceptually linked pilot studies. The first pilot will survey about 500 primary care physicians with vignettes designed to assess knowledge of clinical guidelines on depression treatment and to appraise potential impact of payment change on quality of care. The second study will collect a panel of patient-physician interaction data augmented with patient and physician surveys from about 100 primary care patients for 2 years. Empirical analyses will use structural equation models with categorical dependent variables and latent explanatory variables. Regular meetings will be held with mentors and other advisors to ensure an intensive supervised training and research experience. Such an experience will enable the applicant to use an interdisciplinary approach in a larger future study on how to alter incentives to promote patient-centered mental health treatment process.

描述(由申请人提供)：关于质量改进倡议的大型随机临床试验在改善初级保健中的抑郁症护理方面产生了温和或暂时的效果。因此，越来越多的人呼吁服务研究人员质疑和挑战用于提高精神疾病患者护理质量的方法。虽然经济激励长期以来一直被证明会影响医生的行为，但很少有人注意到支付激励与质量改进的一致性。候选人建议整合经济学和传播学研究的理论和方法，以解决如何在初级保健的精神健康治疗的日常实践中将支付激励与质量改进相结合。申请者要求通过K01计划提供5年的资金，以实施强化的监督培训和研究计划，包括在广泛的临床环境中直接观察精神健康治疗，以及在决策理论和沟通研究方面的额外培训。该培训计划旨在加强对各种动态的专业和经济因素如何影响医生决策的理解。该研究计划将开发一个医生决策的启发式动态经济模型，并用两个概念上相关的先导性研究对其进行测试。第一个试点将对大约500名初级保健医生进行调查，这些调查旨在评估对抑郁症治疗临床指南的了解，并评估支付方式变化对护理质量的潜在影响。第二项研究将收集一组患者-医生互动数据，并通过对大约100名初级保健患者进行为期两年的调查来增强这些数据。实证分析将使用含有类别因变量和潜在解释变量的结构方程模型。将与导师和其他顾问定期举行会议，以确保有密集的监督培训和研究经验。这样的经验将使申请者能够在未来关于如何改变激励机制以促进以患者为中心的精神健康治疗过程的更大规模的研究中使用跨学科方法。