Quality of Mental Health Care in Assisted Living

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DESCRIPTION (provided by applicant): This is an application for a K01 Mentored Research Scientist Career Development Award. The candidate is an epidemiological gerontologist who proposes to acquire specific skills and knowledge related to the field of health services research (HSR). The candidate's long-term career goal is to become a successful, highly productive independent investigator focusing on the epidemiology and care of mental health disorders for elders in multiple settings. Under the mentorship of Drs. P.V. Rabins and C.G. Lyketsos, and the supervision of Drs. S. Zimmerman, A. Rosenblatt, E. Stuart, N. Castle, M. Bruce, and L. Morgan, the candidate will carry out a 5-year career development plan. Short-term goals are to (1) gain practical field and leadership experience by conducting a prospective study focused on facility-level mental health care in assisted living; (2) enhance knowledge of HSR principles and methods and of elders' experiences in health care settings; (3) develop a solid knowledge base in principles of HSR instrument development; (4) foster independence for future work in mental health services research through interactions and collaborations with leaders in related fields; and (5) train in the conduct of responsible research. These goals will be accomplished through didactic training (e.g. 9 courses at the Johns Hopkins School of Public Health); clinical observation (e.g. geriatric psychiatry, ambulatory care outpatient clinics, long-term care); structured and unstructured networking (e.g., regular contact with the mentors/collaborators; conference attendance; travel to sites conducting parallel research); and carrying out a research project. The aims of research project are to: (1) develop an evidence-based instrument to measure facility-level indicators of mental health care quality in assisted living (AL); (2) use the instrument to quantify quality indicators in a random sample of ALs; (3) evaluate differences in the presence of quality indicators between non-dementia-specific care areas (NDSCAs) and dementia-specific care areas (DSCAs); and (4) evaluate the relationship of quality indicators with resident- level characteristics in a pilot sample to ascertain effect size estimates and methods for a future R01 application. Integration of these skills and experiences will provide the candidate with a deep understanding of mental health services research in the context of multi-level factors. RELEVANCE: Mental disorders are highly prevalent in the AL setting and are associated with a number of adverse outcomes including early discharge to nursing homes and poorer quality of life. As more elders with greater psychiatric morbidity utilize this care setting, there are significant public health concerns about mental health care quality. The proposed research is both critical and timely and will provide a new mental health care quality instrument for use in AL and empirical data on presence of evidenced-based quality indicators.