Impact of Depression & Function on Healthcare Use & Cost

描述（由申请人提供）：本指导研究的目的 科学家职业发展奖（KO1）是成为一名独立的研究人员 准备为我们的理解做出独特而重要的贡献， 抑郁症和功能障碍对卫生服务使用的影响， 老年人（65岁以上）的支出。我的三个主题 背景：（a）专门或主要侧重于 老年人;（B）接触和参与晚年精神健康;和（c） 医疗保健使用和支出的横截面分析的专业知识。我 过去的科学史集中在创新的干预研究， 老年患者。我将接受所需的培训和指导 在罗切斯特大学的研究，并在额外的研究， 密歇根大学和康奈尔大学的培训和指导研究 大学目前，人们对抑郁症的影响知之甚少， 在大多数类别中，对医疗保健使用和支出的功能损害 老年患者（例如，初级护理患者，家庭护理患者，以及 社区居住的医疗保健高用户）。我的培训目标 研究职业发展计划是：（1）提高我的知识基础， 与情感性疾病、认知功能障碍和慢性疾病的关系 老年人的疾病和残疾;（2）增加我对 以精神卫生为导向的社区干预措施和公共卫生模式; (3)增加我在纵向数据分析方面的知识和技能;（4）成为 更熟悉负责任地开展研究的要求 （5）计划、组织和实施一个系统的 研究计划增加老年心理健康和功能的知识，我 卫生服务研究和社区老年医学方面的专业知识和技能 干预措施。研究计划的具体目标是：（目标1）更好地 了解重度和亚综合征抑郁症对某些特定 医疗保健使用和支出的类型;（目标2）为了更好地了解 功能损害的影响（日常生活活动的缺陷， 日常生活的工具性活动，以及Ambassador/-移动性）， 具体类型的医疗保健使用和支出;以及（目标3）研究 抑郁症作为功能障碍和 使用/支出和功能障碍作为抑郁症之间的中介 使用/支出。分析计划包括（a）双变量关联， (b)回归分析，（c）检查直接和间接影响，以及 (d)纵向分析适用于3项研究的数据：（1）医疗保险 初级和消费者导向的护理示范（2） 初级保健老年人研究，（3）老年人家庭医疗保健中的抑郁症 患者学习。考虑到医疗保健成本的预期持续上升， 慢性病患者中抑郁症和功能障碍的发病率高 疾病的年龄，了解抑郁症和功能障碍的影响 保健使用和支出对公共卫生特别重要。

DESCRIPTION (provided by applicant): The purpose of this Mentored Research Scientist Career Development Award (KO1) is to become an independent researcher prepared to make a unique and significant contribution to our understanding of the impact of depression and functional impairment on health services use and expenditures among older adults (age 65+). Three themes characterize my background: (a) work-related positions with an exclusive or major focus on the aged; (b) exposure to and involvement with late life mental health; and (c) expertise in crosssectional analysis of healthcare use and expenditures. My past scientific history has focused on innovative intervention studies of elderly patients. I will receive the needed training and conduct mentored research at the University of Rochester, with additional study at the University of Michigan and training and mentored research at Cornell University. Presently little is known about the impact of depression and functional impairment on healthcare use and expenditures among most categories of elderly patients (e.g., primary care patients, home care patients, and community-dwelling high users of medical care). The Training Objectives of my Research Career Development Plan are to: (1) Improve my knowledge base in relation to affective illness, cognitive dysfunction, and chronic illness comorbidity and disability in elderly persons; (2) Increase my knowledge of mental health oriented community-based interventions and public health models; (3) Add to my knowledge and skills in longitudinal data analysis; (4) Become more familiar with the requirements for responsible conduct of research involving human subjects; and (5) Plan, organize, and carrying out a systematic research program adding knowledge of geriatric mental health and function to my expertise and skills in Health Services Research and community-based geriatric interventions. The Specific Aims of the Research Plan are: (Aim 1) To better understand the impact of major and subsyndronml depression on certain specific types of healthcare use and expenditures; (Aim 2) To better understand the effect of functional impairment (deficits in activities of daily living, instrumental activities of daily living, and ambulation/-mobility) on certain specific types of healthcare use and expenditures; and (Aim 3) To study the role of depression as a mediator between functional impairment and use/expenditures, and functional impairment as a mediator between depression and use/expenditures. The Analytic Plan consists of (a) bivariate associations, (b) regression analyses, (c) an examination of direct and indirect effects, and (d) longitudinal analyses applied to data from 3 studies: (1) the Medicare Primary and Consumer-Directed Care Demonstration (2) the Depression Outcome in Primary Care Elderly study, and (3) the Depression in Elderly Medical Homecare Patients study. Given the expected continuing rise in healthcare costs and the high prevalence of depression and functional impairment among the chronically ill aged, understanding the impact of depression and functional impairment on healthcare use and expenditures is of particular public health importance.