POPULATION BASED PSYCHIATRIC INTERVENTION--PRIMARY CARE

这是NIMH独立科学家奖(ISA)的申请。这 格兰特以卡顿博士在开发成本方面的广泛研究为基础- 有效的干预措施以提高普通儿童的护理质量 精神疾病，如初级保健中的严重抑郁症和 专科医疗系统，并提高对 情感障碍和焦虑症之间的联系，原因不明的医学 症状、卫生保健利用和费用、功能残疾和 生活质量。该研究计划建立在该公司持有的R01上 申请者以及其他正在进行的旨在改善智力的研究 医疗系统中的医疗保健。 ISA将达到的四个具体职业目标是：1)测试 论基于人群的疾病管理的普适性 我的研究小组在城市医疗保健组织中开发和测试的干预措施 其他地域、社会经济和临床人群的患者；2) 继续将我的研究团队的知识和专业知识扩展到 为23名初中生提供符合成本效益的重度抑郁症干预 (三)发展合作关系。 通过多站点研究网络或大型管理型医疗系统 为了证明改善对重度抑郁症的治疗 慢性病患者将改善：习惯化 令人反感的医学症状、功能、生活质量和对 医疗保健；以及4)继续我广泛的地方和国家 初级调查员的指导。 这些目标将通过持续和扩大的研究来实现 活动，与当地和资深科学家的合作 全国性和研究生水平的流行病学、卫生学课程工作 华盛顿大学公共卫生学院经济学教授。我 具体建议增加我对以人口为基础的知识 经过测试的疾病管理方法，以改善对 常见疾病，如高血压和糖尿病 护理系统，增加我的成熟度和对成本的了解- 有效性和成本-效用分析，并改进 衡量抑郁症间接成本的领域，如减少 在工作效率和家庭负担方面。 在申请人职业生涯的这个阶段，ISA将提供 行政责任，并将提供时间和资源 需要利用一个由高级调查人员组成的优秀网络 将提供出色的培训活动和协作 机遇。

This is a request for an NIMH Independent Scientist Award (ISA). This grant builds on Dr. Katon's extensive research in developing cost- effective interventions to improve the quality of care of common psychiatric illnesses such as major depression within the primary care and the specialty medical systems and to improve understanding about the connection between affective and anxiety disorders, unexplained medical symptoms, health care utilization and costs, functional disability and quality of life. The research program builds on an R01 held by the applicant as well as other ongoing studies aimed at improving mental health care in medical systems. The four specific career goals that will be met by the ISA are: 1) to test the generalizability of the population-based disease management interventions that my research group hs developed and tested in urban HMO patients in other geographic, socioeconomic, and clinical populations; 2) To continue to extend my research teams' knowledge and expertise to provide cost-effective intervention for major depression to the 23 primary care clinics of Group Health Cooperative; 3) To develop cooperative ties with a multi-site research network or large managed care system in order to demonstrate that improving the treatment of major depression in patients with chronic medical illness will improve: habituation to aversive medical symptoms, functioning, quality of life, and adherence to medical regimens; and 4) To continue my extensive local and national mentorship of junior investigators. These goals will be met through continued and expanded research activities, collaborations with senior scientists both locally and nationally, and graduate level course work in epidemiology, health economics at the University of Washington School of Public Health. I propose specifically to increase my knowledge about population-based disease management methods that have been tested to improve the care of common medical illness such as hypertension and diabetes in the primary care system, increase my sophistication and knowledge in cost- effectiveness and cost-utility analysis, and improve the knowledge base of the field in measurement of indirect costs of depression such as decreases in work productivity and family burden. An ISA at this stage of the applicant's career will provide release from administrative responsibilities and will provide the time and resources needed to capitalize on an excellent network of senior investigators who will provide outstanding training activities and collaborative opportunities.