Population-Based Psychiatric Intervention--Primary Care

描述（由申请人提供）：这是NIMH面向患者研究的职业中期研究者奖的竞争性更新申请。这项资助建立在Katon博士在开发具有成本效益的干预措施方面的广泛研究基础上，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在糖尿病等合并症患者中的患病率和影响的理解。Katon博士20多年来成功指导初级研究人员成为独立研究人员的经验，包括他担任NIMH T32 NRSA初级保健精神病学奖学金主任的15年经验，也是这项资助的基础。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的能力，以及开展他目前在NIMH R01中提出的以患者为导向的研究以及其他正在进行的和新的研究建议。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以两种方式发展：a)流行病学数据显示抑郁/焦虑对症状负担、功能、生活质量、自我保健、医疗费用和医疗结果的横断面和纵向影响；(b)干预研究表明，慢性病患者抑郁的护理质量和结局的改善可以减轻症状负担，改善功能和生活质量，改善自我护理和改善疾病结局（如糖化血红蛋白），成本合理；2)通过以下方式继续传播协作式护理模式：a)扩大该模式在改善老年人、服务不足人群和焦虑症患者预后方面的成本效益的证据；B)扩大证据，证明这些模式对与政策有关的结果有重大影响，例如在合理的医疗费用下减少休假天数；C)开发协作护理项目实施的保真度测量，可以测试协作护理的哪些组成部分对改善结果最重要；d)制定以证据为基础的护理质量指南，以优化医疗保健服务绩效指标的抑郁结果；3)继续扩大Katon博士对从事心理健康服务研究的初级调查员的指导。这些目标将通过继续和扩大的研究活动、华盛顿大学公共卫生学院的流行病学、保健服务、保健管理、生物统计学和保健经济学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、元分析、测量间接成本（工作效率和缺勤）、开发协作护理的保真度测量以及在传播协作护理模式中加强对组织和监管问题的理解方面提出的前沿研究活动。在申请人职业生涯的这个阶段，K24将为申请人提供行政责任的释放，并提供所需的时间和资源，以利用优秀的高级研究人员网络，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.