Economic Analysis of Depression Treatment Process

描述（由申请人提供）：关于质量改进计划的大型随机临床试验对改善初级保健中的抑郁症护理产生了适度或暂时的影响。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，但很少有人关注支付激励与质量改善的一致性。候选人建议整合经济学和传播学研究的理论和方法，以解决如何将支付激励与初级保健中心理健康治疗的日常实践中的质量改进相结合。申请人要求通过K01计划获得5年的资助，以开展一项受监督的强化培训和研究计划，包括在广泛的临床环境中直接观察心理健康治疗，以及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专业和经济因素如何影响医生决策的理解。该研究项目将开发一个启发式的医生决策动态经济模型，并通过两个概念相关的试点研究对其进行测试。第一个试点项目将对大约500名初级保健医生进行调查，并提供小短片，以评估他们对抑郁症治疗临床指南的了解程度，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，并对大约100名初级保健患者进行为期2年的患者和医生调查。实证分析将使用具有分类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，以确保密集的监督培训和研究经验。这样的经验将使申请人能够在未来更大的研究中使用跨学科的方法，研究如何改变激励机制，以促进以患者为中心的心理健康治疗过程。

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.