Improving Metabolic Screening in Diverse Severely Mentally Ill Populations

描述(由申请人提供)：本K23指导患者导向研究职业发展奖的申请将支持候选人Christina Mangurian博士的关键额外培训，Christina Mangurian博士是加州大学旧金山分校(UCSF)的精神病学家，总部设在旧金山综合医院。曼古里安博士的研究计划侧重于改善社区精神卫生诊所服务的种族和种族多元化的严重精神病患者群体的代谢筛查。为了进一步发展她作为一名精神卫生服务研究人员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。曼古里安博士组建了一个由多学科导师组成的团队，为她的培训和研究提供便利。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，他在初级保健服务研究方面拥有国际专业知识，包括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，包括他致力于改善对服务不足的人口的服务。他的专业知识将得到加州大学旧金山分校精神卫生服务研究员Martha Shumway博士和华盛顿大学临床研究员John Newcomer博士的补充，John Newcomer博士是严重精神疾病人群代谢风险的临床和实验室测量专家，并将监测目标转化为临床实践。患有严重精神疾病的人平均比一般人早25年死亡，最常见的是死于心血管疾病。用于治疗这一人群的抗精神病药物引起的代谢异常(如糖尿病、高血压、血脂异常)可能会导致心血管疾病的发生率增加。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。迫切需要基于证据的、可推广的干预措施，这些干预措施可以可行地实施，以改善社区精神卫生诊所的新陈代谢筛查，这些诊所主要为弱势群体提供服务。因此，在目标1中，曼古里安博士建议对在旧金山县社区精神卫生诊所接受服务的患有严重精神疾病的成年人的代谢筛查率进行表征。在目标2中，她将量身定做一项干预措施，通过让多个利益攸关方参与并专注于可能影响高危种族/民族亚群的障碍，改善患有严重精神疾病的成年人的代谢筛查。在目标3中，她将对干预进行试点研究。这项研究的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应用程序的基础，以研究这种干预的有效性。

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.