Population-Based Psychiatric Intervention--Primary Care

描述(由申请人提供)：这是NIMH以患者为中心的研究中职业生涯中期研究员奖的竞争性续签请求。这笔赠款建立在Katon博士的广泛研究基础上，该研究旨在开发具有成本效益的干预措施，以改善初级保健系统中患有严重抑郁症和恐慌症的患者的护理质量和结果，并加深对患有糖尿病等共病的抑郁症和焦虑症患者的患病率和影响的了解。这笔赠款还建立在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基础上，包括他作为NIMH T32 NRSA初级护理-精神病学研究金主任的15年经验。K24将增强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以及执行他目前的NIMH R01和其他正在进行的和新的研究提案中提出的以患者为导向的研究的能力。K24将实现的三个具体职业目标是：1)在基于人群的研究中证明抑郁症和焦虑症对慢性疾病患者的影响。基于人群的研究将以两种方式提供证据：a)流行病学数据，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；b)干预研究表明，改善慢性病患者的护理质量和抑郁结果会以合理的成本减少症状负担、改善功能和生活质量、改善自我护理和改善疾病结果(如HbA1c)；2)通过以下方式继续传播协作护理模式：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果方面的成本效益的证据；b)扩大这些模式对政策相关结果有重大影响的证据，例如以合理的医疗费用休息天数和减少天数；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在改善结果方面最重要；以及d)制定基于证据的护理质量指南，以优化HEDIS绩效测量的抑郁症结果；以及3)继续扩大卡顿博士对参与精神健康服务研究的初级调查人员的指导。这些目标将通过持续和扩大的研究活动、华盛顿大学公共卫生学院流行病学、保健服务、保健管理、生物统计学和保健经济学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，并加强拟议的尖端研究活动，包括成本效益分析、荟萃分析、间接成本(工作效率和缺勤)的衡量、协作护理保真度的开发以及在传播协作护理模式方面对组织和监管问题的更好理解。在申请人职业生涯的这个阶段，K24将提供从行政责任中解放出来，并提供所需的时间和资源，以利用一个优秀的高级调查人员网络，他们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.