Indianapolis Interventions and Practice Research Infrastructure Program

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DESCRIPTION (provided by applicant): Over the past few years, multiple studies have reported promising results from integrated care management models to improve the care of older adults with mental illness in primary care settings. The National Advisory Mental Health Council's Workgroup on Aging Research (2006) reported, however, that "integrated case management for mental illness in old age is unlikely to be implemented until the factors that affect its adoption are understood.... Dissemination and implementation research to address these issues and many others is needed to bridge the gap between clinical research and everyday practice by building a knowledge base about how mental health care information and new practices are transmitted and translated for health care service use in specific settings." NIMH research over the past 30 years has identified primary care as the site of care where most patients with mental illness receive care. In this revised application, we propose to build on our research experience at the intersection of psychiatry, primary care, and geriatrics by establishing an IP-RISP for the study of depression and cognitive impairment among older adults in primary care. The Indianapolis IP-RISP will advance implementation science by partnering our research team with an urban community-based health care system serving vulnerable older adults, including a high proportion of African Americans. In addition, building a laboratory for mental health services research within primary care allows opportunities to study how comorbid medical conditions (e.g. cardiovascular disease) affect the process and outcomes of care. Our partnership is designed to identify barriers and facilitators to translating knowledge into routine clinical practice. Based on an needs assessment with our community partner, we are proposing two pilot projects: (a) create and evaluate an integrated electronic medical record to support clinical care and research for older adults with depression or cognitive impairment; and (b) implement a collaborative care model for older adults with depression, cognitive impairment, or both and also integrate the care of cardiovascular disease.