Population-Based Psychiatric Intervention--Primary Care

描述（由申请人提供）：这是NIMH中期职业研究者奖在以患者为导向的研究中的竞争更新请求。 Katon博士在开发具有成本效益的干预措施方面进行了广泛的研究，以提高初级保健系统中重度抑郁症和恐慌症患者的护理质量和结果，并提高对抑郁症和焦虑症的患病率和影响的理解。 Katon博士二十多年来成功指导初级研究人员成为独立研究人员的经验，包括他作为NIMH T32 NRSA初级护理精神病学奖学金主任的15年经验。 Katon博士在流行病学，生物统计学，卫生经济学和疾病管理方面的专业知识，这将提高他指导初级同事的能力，并开展他目前的NIMH R 01和其他正在进行的新研究提案中提出的以患者为导向的研究。 K24将满足的三个具体职业目标是：1）在基于人群的研究中证明抑郁和焦虑障碍对慢性疾病患者的影响。 基于人群的研究的证据将通过两种方式得到：a）显示抑郁/焦虑对症状负担、功能、生活质量、自我护理、医疗费用和医疗结果的横向和纵向影响的流行病学数据;和B）干预研究表明，改善慢性病患者的护理质量和抑郁症的结果导致症状负担降低，改善功能和生活质量，改善自我护理和改善疾病结局（如HbA 1c）以合理的成本; 2）通过以下方式继续传播合作护理模式：a）扩大该模式在改善老年人、服务不足人群和焦虑症患者的结局方面的成本效益的证据; B）扩大证据，证明这些模型对政策相关结果产生重大影响，例如休假天数和减少合理医疗费用天数; c）、开发协作护理计划实施的保真度测量，可以测试协作护理的哪些组成部分最重要，改善成果;和d）制定以证据为基础的护理质量指南，以优化HEDIS绩效指标的抑郁症结局;和3）继续扩大Katon博士对参与心理健康服务研究的初级研究人员的指导。 这些目标将通过继续和扩大研究活动、在华盛顿大学公共卫生学院开设流行病学、保健服务、保健管理、生物统计学和保健经济学方面的研究生课程以及外部顾问的指导来实现。 这些课程将提高Katon博士作为导师的能力，并加强在成本效益分析，荟萃分析，衡量间接成本（工作生产力和缺勤），开发合作护理的忠诚度措施以及提高对传播合作护理模式中的组织和监管问题的理解方面的拟议尖端研究活动。 在申请人职业生涯的这一阶段，K24将提供从行政责任中解脱出来的机会，并提供利用高级调查员的优秀网络所需的时间和资源，这些高级调查员将提供指导和潜在的合作研究机会。

DESCRIPTION (provided by applicant): This is a request for a competing renewal for an NIMH Midcareer Investigator Award in Patient-Oriented Research. This grant builds on Dr. Katon's extensive research in developing cost-effective interventions to improve the quality of care and outcomes for patients with major depression and panic disorder within primary care systems, and to improve understanding about the prevalence and impact of depressive and anxiety disorders in patients with comorbid medical disorders such as diabetes. The grant also builds on Dr. Katon's experience over two decades in successfully mentoring junior investigators to become independent researchers, including his 15 years of experience as Director of an NIMH T32 NRSA Primary Care-Psychiatry Fellowship. This K24 will enhance Dr. Katon's expertise in epidemiology, biostatistics, health economics and disease management, which will improve his ability to mentor junior colleagues as well as to carry out the patient-oriented research proposed in his current NIMH R01 and other ongoing and new research proposals. The three specific career goals that will be met by the K24 are: 1) To demonstrate in population-based studies the impact of depressive and anxiety disorders in patients with chronic medical illness. The evidence from the population-based studies will be developed in two ways: a) epidemiologic data showing the cross-sectional and longitudinal effect of depression/anxiety on symptom burden, functioning, quality of life, self-care, medical costs and medical outcomes; and b) intervention studies demonstrating that improved quality of care and outcomes of depression in patients with chronic illness results in decreased symptom burden, improved functioning and quality of life, improved self-care and improved disease outcomes (such as HbA1c) at reasonable costs; 2) To continue to disseminate collaborative models of care by: a) expanding evidence of this model's cost-effectiveness in improving outcomes of elderly, underserved populations, and patients with anxiety disorders; b) expanding the evidence that these models have a significant impact on policy-relevant outcomes such as days off work and cut down days at reasonable medical costs; c) developing a fidelity measure of program implementation of collaborative care that can test which components of collaborative care are most important in improving outcomes; and d) developing evidence-based quality of care guidelines for optimizing depression outcomes for HEDIS performance measures; and 3) To continue to expand Dr. Katon's mentorship of junior investigators involved in mental health services research. These goals will be met through continued and expanded research activities, graduate-level coursework in epidemiology, health services, health management, biostatistics and health economics at the University of Washington School of Public Health and mentorship from external consultants. These courses will improve Dr. Katon's ability as a mentor as well as enhancing the proposed cutting-edge research activities in cost-effectiveness analysis, meta-analysis, measuring indirect costs (work productivity and absenteeism), development of a fidelity measure of collaborative care and an enhanced understanding of organizational and regulatory issues in disseminating collaborative care models. A K24 at this stage of the applicant's career will provide release from administrative responsibilities and provide the time and resources needed to capitalize on an excellent network of senior investigators who will provide mentoring and potential collaborative research opportunities.