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Improving Metabolic Screening in Diverse Severely Mentally Ill Populations

改善不同严重精神疾病人群的代谢筛查

基本信息

批准号：
8241654
负责人：
Christina Mangurian
金额：
$ 17.77万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-08-16 至 2017-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8241654
关键词：
Adult Antipsychotic Agents Applications Grants Area Attention Biometry California Cardiovascular Diseases Clinic Clinical Clinical Decision Support Systems Clinical Investigator Clinical Research Communities Complement Complex County Dedications Diabetes Mellitus Dyslipidemias Early Diagnosis Early treatment Effectiveness Effectiveness of Interventions Electronics Ensure Epidemiology Ethnic Origin Evidence based intervention Focus Groups General Hospitals General Population Goals Guidelines Health Services Research Healthcare Systems High Prevalence Hypertension International Internist Intervention Knowledge Laboratories Language Lead Link Measurement Medicaid Medicine Mental Health Mental Health Services Mentally Ill Persons Mentored Patient-Oriented Research Career Development Award Mentors Metabolic Metabolic Diseases Methods Minority Modeling Monitor Online Systems Performance Pharmaceutical Preparations Pilot Projects Population Primary Health Care Provider Psychiatrist Public Health Publications Race Recommendation Research Research Design Research Methodology Research Personnel Research Training Risk San Francisco Screening procedure Services Solutions Surface System Target Populations Time Training Translations Underrepresented Minority Underserved Population Universities Visit Vulnerable Populations Washington Weight Gain base cardiovascular risk factor career clinical practice evidence base experience health disparity high risk implementation research improved multidisciplinary programs racial and ethnic randomized trial research study severe mental illness tool uptake

项目摘要

DESCRIPTION (provided by applicant): This application for a K23 Mentored Patient-Oriented Research Career Development Award will support critical additional training for the candidate, Dr. Christina Mangurian, a psychiatrist at the University of California, San Francisco (UCSF), based at San Francisco General Hospital. Dr. Mangurian's research plan focuses on improving metabolic screening among ethnically and racially diverse severely mentally ill populations served in community mental health clinics. To further develop her career as a mental health services researcher and to accomplish her research plan, she requires specific training in three areas: 1) clinical research methods (e.g., biostatistics, epidemiology, and mixed methods); 2) implementation research; and 3) mental health disparities research. Dr. Mangurian has assembled a multidisciplinary team of mentors to facilitate her training and research. Her primary mentor is Dr. Dean Schillinger, a UCSF primary care internist with international expertise in primary care health services research, including implementation research in public health settings. He will oversee all training and research plans, providing his wealth of experience in this field, including his dedication to improving services for underserved populations. His expertise will be complemented by Dr. Martha Shumway, a UCSF mental health services researcher; and Dr. John Newcomer, a Washington University clinical investigator who is an expert in clinical and laboratory measurement of metabolic risk in severely mentally ill populations and in the translation of monitoring objectives into clinical practice. People with severe mental illness die, on average, 25 years earlier than the general population, most often from cardiovascular disease. Metabolic abnormalities (e.g., diabetes, hypertension, dyslipidemia) resulting from antipsychotic medications used to treat this population can lead to increased rates of cardiovascular disease. Despite national guidelines emphasizing the importance of screening, metabolic screening rates for this population remain low. There is an urgent need for evidence-based, generalizable interventions that can be feasibly implemented to improve metabolic screening at community mental health clinics where this vulnerable population is primarily served. Therefore, in Aim 1, Dr. Mangurian proposes to characterize metabolic screening rates among adults with severe mental illness who receive services at community mental health clinics in San Francisco County. In Aim 2, she will tailor an intervention to improve metabolic screening for adults with severe mental illness by engaging multiple stakeholders and focusing on barriers that may impact high-risk racial/ethnic subpopulations. In Aim 3, she will conduct a pilot study of the intervention. The results of this research will contribute new information about implementation efforts to improve metabolic screening in community mental health clinics and will form the basis of an R01 application to study the effectiveness of this intervention. PUBLIC HEALTH RELEVANCE: The majority of people with severe mental illness are prescribed antipsychotic medications, many of which result in metabolic abnormalities (e.g., dyslipidemia, diabetes) and in turn increase cardiovascular risk. We will evaluate whether a pragmatic intervention - a mandatory annual metabolic screening visit by a psychiatrist, which is linked to a web-based electronic referral and clinical decision support tool - can be feasibly implemented at community mental health clinics to enhance early detection and treatment of metabolic disorders and thereby reduce the high prevalence of cardiovascular disease among people with severe mental illness.

描述（由申请人提供）：本申请K23指导患者导向研究职业发展奖将支持候选人Christina Mangurian博士的重要额外培训，她是加州大学旧金山分校（UCSF）的精神病学家，总部设在旧金山总医院。Mangurian博士的研究计划侧重于改善在社区精神卫生诊所服务的不同种族和种族的严重精神疾病人群中的代谢筛查。为了进一步发展她作为精神卫生服务研究者的职业生涯并完成她的研究计划，她需要在三个方面进行专门的培训：1)临床研究方法（如生物统计学，流行病学和混合方法）；2)实施研究；3)心理健康差异研究。Mangurian博士组建了一个多学科的导师团队，以促进她的培训和研究。她的主要导师是加州大学旧金山分校的初级保健内科医生Dean Schillinger博士，他在初级保健卫生服务研究方面具有国际专长，包括在公共卫生环境中的实施研究。他将监督所有培训和研究计划，提供他在这一领域的丰富经验，包括他致力于改善服务不足人群的服务。他的专业知识将由加州大学旧金山分校心理健康服务研究员玛莎·沙姆韦博士补充；John Newcomer博士是华盛顿大学的临床研究员，他是严重精神疾病人群代谢风险的临床和实验室测量专家，也是将监测目标转化为临床实践的专家。患有严重精神疾病的人平均比一般人早死25年，通常死于心血管疾病。用于治疗这一人群的抗精神病药物导致的代谢异常（如糖尿病、高血压、血脂异常）可导致心血管疾病的发病率增加。尽管国家指南强调筛查的重要性，但这一人群的代谢筛查率仍然很低。迫切需要一种基于证据的、可推广的干预措施，这种干预措施可以切实实施，以改善社区精神卫生诊所的代谢筛查，而社区精神卫生诊所主要为这些弱势群体提供服务。因此，在Aim 1中，Mangurian博士建议表征在旧金山县社区精神卫生诊所接受服务的严重精神疾病成人的代谢筛查率。在目标2中，她将通过参与多个利益相关者并关注可能影响高风险种族/民族亚人群的障碍，量身定制一种干预措施，以改善患有严重精神疾病的成年人的代谢筛查。在第三阶段，她将对该干预措施进行试点研究。本研究结果将为改善社区精神卫生诊所代谢筛查的实施工作提供新的信息，并将形成R01应用于研究这种干预措施的有效性的基础。