Impact of Depression & Function on Healthcare Use & Cost

说明(由申请人提供)：本指导研究的目的 科学家职业发展奖(KO1)将成为一名独立研究员 准备为我们的理解做出独特而重大的贡献 抑郁和功能障碍对卫生服务利用和 老年人(65岁以上)的支出。三个主题描述了我的 背景：(A)与工作有关的职位，专门或主要侧重于 老年人；(B)接触和参与晚年精神健康；及(C) 医疗保健使用和支出的横断面分析方面的专业知识。我的 过去的科学史把重点放在创新干预研究上 老年病人。我将接受所需的培训和指导 在罗切斯特大学进行研究，并在 密歇根大学和康奈尔大学的培训和指导性研究 大学。目前人们对抑郁症的影响知之甚少 在大多数类别中，医疗保健使用和支出的功能障碍 老年患者(例如，初级护理患者、家庭护理患者和 居住在社区的医疗服务高使用者)。我的培训目标 研究职业发展计划是：(1)改善我的知识基础 与情感性疾病、认知功能障碍和慢性病的关系 老年人的共病和残疾；(2)增加我对 面向心理健康的社区干预和公共卫生模式； (3)增加我在纵向数据分析方面的知识和技能；(4)成为 更熟悉负责任地进行研究的要求 涉及人类主体；(5)计划、组织和实施系统的 我的研究项目增加了老年人心理健康和功能方面的知识 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型抑郁症对某些特定疾病的影响 医疗保健使用和支出的类型；(目标2)更好地了解 功能障碍的影响(日常生活活动能力障碍， 日常生活和步行/活动的工具性活动) 医疗保健用途和支出的具体类型；以及(目标3)研究 抑郁在功能障碍和抑郁之间的中介作用 使用/支出和功能损害作为抑郁之间的中介 和使用/支出。分析计划包括(A)双变量关联， (B)回归分析；(C)直接和间接影响的审查；和 (D)对3项研究的数据进行纵向分析：(1)医疗保险 初级护理和以消费者为导向的护理示范(2) 老年初级保健研究，以及(3)老年医疗保健中的抑郁 病人研究。鉴于预计医疗成本将继续上升，以及 慢性精神分裂症患者抑郁和功能障碍的高患病率 老年不佳，了解抑郁和功能障碍对 医疗保健的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.