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Mental Health Communication in Elderly Primary Care Visits and Economic Outcomes

老年人初级保健就诊和经济成果中的心理健康沟通

基本信息

批准号：
8103654
负责人：
MING TAI-SEALE
金额：
$ 54.48万
依托单位：
PALO ALTO MEDICAL FOUNDATION RES INST
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-07-24 至 2012-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8103654
关键词：
Address Adherence American Medical Association Area Behavior Behavioral Caring Client satisfaction Clinic Clinical Clinical Data Code Communication Communication Research Comorbidity Cost Effectiveness Analysis Data Data Sources Databases Dimensions Distal Economics Elderly Elements Empathy Environment Evidence based treatment Foundations Funding Goals Health Health Communication Health Personnel Health Services Health Services Research Health Services for the Aged Health Status Health system Healthcare Institute of Medicine (U.S.)Integrated Delivery Systems Intervention Journals Length Link Location Malpractice Measures Medical Mental Depression Mental Health Mental Health Services Mental disorders Methods Michigan Minority Office Visits Outcome Output Patient Participation Patient observation Patients Perception Pharmaceutical Preparations Physicians Policies Preventive Primary Care Physician Primary Health Care Probability Process Productivity Psyche structure Public Health Race Randomized Controlled Trials Recommendation Records Research Research Infrastructure Risk Factors Science Services Source Surveys Testing Time Translating Treatment Cost Trust United States National Institutes of Health Visit Work abstracting base biopsychosocial checkup examination clinical practice communication behavior comparative effectiveness compliance behavior cost cost effectiveness design economic outcome effectiveness research evidence base innovation insight interest physical conditioning psychologic response social socioeconomics statistics suburb time use treatment adherence treatment planning

项目摘要

The medical office visit is the foundation of medical care and one of the most important professional activities of primary care physicians who are often the only source of mental health services for older adults. Evidence continues to show that the gap between science and clinical practice remains wide: as many as one half of older adults with a recognized mental disorder fail to receive any mental health services, and even fewer receive evidence-based treatments. Racial minority patients fare even worse. It is an urgent public health concern that such a high proportion of patients needing mental health services are without access to evidence-based care and that racial disparities in access to quality mental health care persist despite advancements in efficacious treatments for mental illnesses. Direct observation of how patients and physicians interact has led to research findings that are straightforward and easily understood by the public and policymakers. It offers a new perspective to study physicians' work and patients' contributions with potentially important new insights. We propose to leverage the infrastructure and data afforded by an ongoing NIH- funded study which is audio-recording 800 annual physical exam visits (checkups designed for physicians to comprehensively review their patients' health) among socioeconomically diverse older adults in a large integrated delivery system, the Henry Ford Health System, in Detroit Michigan and its surrounding suburbs. The proposed study is within the scope of the economics of mental health. We plan to apply mixed methods approach and combine perspectives from mental health services research with behavioral economics, communication research, and statistics. We will use data from audio-recordings, administrative benefits, medication dispensing, claims and encounter records, and surveys of patients and physicians to address the Specific Aims of our study: Aim 1: Examine the productivity of physician-patient communication by linking elements of quality of communication on mental health in the context of busy clinics and competing demands from co-morbidities in routine annual checkups with intermediate outcomes such as patient's satisfaction and treatment adherence and distal clinical and economic outcomes including service use and costs. Aim 2: Testing for racial disparities in communication content and time using the definition proposed by the Institute of Medicine in Unequal Treatment. We will first qualitatively compare the content and time devoted to mental health and physical health communications between racially concordant and discordant patient-physician pairs. We will assess the contribution of factors that are germane to the practice environment and malleable to policy, e.g., length of visit, co-location of mental and physical health providers to observed disparities. At the completion of the study, we seek to formulate concrete recommendations about specific organizational or clinical interventions that can address these national priorities: translating evidence to practice and eliminating disparities.

就诊是医疗保健的基础，也是初级保健医生最重要的专业活动之一，初级保健医生往往是老年人心理健康服务的唯一来源。证据不断表明，科学与临床实践之间的差距仍然很大：多达一半患有公认精神障碍的老年人未能接受任何心理健康服务，接受循证治疗的人更少。少数族裔患者的情况甚至更糟。这是一个紧迫的公共卫生问题，因为大量需要精神卫生服务的患者无法获得循证护理，而且尽管精神疾病的有效治疗方法取得了进步，但在获得优质精神卫生保健方面的种族差异仍然存在。对患者和医生如何互动的直接观察得出了直接且易于公众和政策制定者理解的研究结果。它提供了一个新的视角来研究医生的工作和患者的贡献，并具有潜在的重要新见解。我们建议利用 NIH 资助的一项正在进行的研究提供的基础设施和数据，该研究对密歇根州底特律及其周边郊区的大型综合服务系统亨利·福特医疗系统中社会经济多样化的老年人进行的 800 次年度体检（为医生全面审查患者健康状况而设计的检查）进行录音。拟议的研究属于心理健康经济学的范围。我们计划采用混合方法，并将心理健康服务研究的观点与行为经济学、传播研究和统计学相结合。我们将使用来自录音、行政福利、药物配发、索赔和就诊记录以及患者和医生调查的数据来实现我们研究的具体目标：目标 1：通过在繁忙的诊所和例行年度检查中共病的竞争性需求和患者满意度和治疗等中间结果的背景下，通过将心理健康沟通质量要素联系起来，检查医患沟通的效率依从性以及远端临床和经济结果，包括服务使用和成本。目标 2：使用不平等待遇医学研究所提出的定义来测试沟通内容和时间方面的种族差异。我们将首先定性比较种族一致和不一致的医患对之间用于心理健康和身体健康沟通的内容和时间。我们将评估与实践环境密切相关且可影响政策的因素的贡献，例如就诊时间、心理和身体健康提供者的同地办公对观察到的差异的影响。研究完成后，我们寻求就具体的组织或临床干预措施制定具体建议，以解决这些国家优先事项：将证据转化为实践并消除差异。