The Spatio-Temporal Diffusion of Psychotropic Medication to Rural Children

描述（由申请人提供）：我们的长期研究目标是开发干预措施，加速农村地区采用循证实践，从而减轻农村儿童的精神疾病负担。农村儿童患精神疾病的比率与城市儿童相当，但生活在不同的社会、文化和经济环境中。必须充分探索这些患者、社区、临床医生和卫生系统因素之间的联系，以便了解循证实践从城市到农村地区以及在农村地区之间的传播。我们进行这些研究的基本原理是，更好地了解哪些地方的创新被快速或缓慢地采用，将有助于更快、更有效地传播有关新实践的信息，并促进创新实践。有两个具体目标：(1)开发一个地理信息系统（GIS），用于识别精神药物处方变化的位置。我们将采用多层次的统计模型来确定与儿童开精神药物的比率和地点相关的因素。(2)明确儿童精神药物处方中涉及的扩散机制。我们的假设是，信息是通过社会传染过程传播的，早期和晚期处方者在地理上聚集在一起。地理信息系统（GIS）和空间统计的最新创新促进了复杂扩散过程的建模。通过“综合征监测”和时空聚类统计的使用，使前瞻性传播成为可能。该方法使我们能够研究扩散集群随时间的发展及其发展中的特定地点因素。我们的方法是创新的，因为这些方法通常用于阻止负面事件（疾病）的传播，而不是促进积极事件的传播，例如采用基于证据的做法的增长。这项研究与公共卫生有关，因为其结果将有助于消除心理健康方面的地域差异。这项研究还将加深对农村精神卫生服务的可得性、可及性、需求和使用的理解。

DESCRIPTION (provided by applicant): Our long term research goal is to develop interventions that accelerate the adoption of evidence-based practices in rural areas and thereby reduce the burden of mental illness on rural children. Rural children experience mental illness at rates equivalent to urban children but live in a different social, cultural, and economic milieu. The nexus of these patient, community, clinician and health systems factors must be fully explored in order to understand the diffusion of evidence-based practices from urban to rural areas and among rural areas. Our rationale for these studies is that a better understanding of the locations in which innovations are adopted quickly or slowly would allow faster, more efficient information dissemination regarding new practices as well as promote innovative practice. There are two specific aims: (1) Develop a Geographic Information System (GIS) for identifying the locations of changes in prescribing for psychotropic medications. We will employ multi-level statistical models to determine the factors that are associated with the rate and locations of prescribing psychotropics to children. (2) Identify the mechanism of diffusion involved in the prescription of psychotropic medications to children. Our hypothesis is that information is transmitted through a social contagion process where early and late prescribers cluster geographically. Geographic information systems (GIS) and recent innovations in spatial statistics facilitate the modeling of complex diffusion processes. Prospective dissemination is made possible through "syndromic surveillance" and the use of space-time cluster statistics. The approach permits us to study the development of diffusion clusters over time and the location-specific factors in their development. Our approach is innovative in that these methods are usually applied to arresting the spread of negative events (disease) rather than facilitating the spread of positive events such as growth in the adoption of evidence-based practices. This research is relevant to public health because the results will help in eliminating geographic disparities in mental health. The research will also deepen the understanding of rurality with respect to availability, access, need, and use of mental health services.