Quality of Mental Health Care in Assisted Living

描述(申请人提供)：这是一份K01指导研究科学家职业发展奖的申请书。应聘者是一名流行病学老年病学家，他建议获得与卫生服务研究(HSR)领域相关的特定技能和知识。候选人的长期职业目标是成为一名成功、高效的独立调查员，专注于多种环境下老年人精神健康障碍的流行病学和护理。在P.V.Rabins博士和C.G.Lyketsos博士的指导下，以及S.Zimmerman博士、A.Rosenblatt博士、E.Stuart博士、N.Castle博士、M.Bruce博士和L.Morgan博士的监督下，候选人将实施一项为期5年的职业发展计划。短期目标是(1)通过进行一项以辅助生活中设施层面的精神健康护理为重点的前瞻性研究，获得实际的现场和领导经验；(2)增进对高铁原则和方法的了解，以及长者在医疗环境中的经验；(3)建立关于高铁仪器开发原理的坚实知识库；(4)通过与相关领域的领导人的互动和合作，培养未来精神健康服务研究工作的独立性；以及(5)培训进行负责任的研究。这些目标将通过教学培训(例如，约翰霍普金斯大学公共卫生学院的9门课程)、临床观察(例如老年精神病学、门诊诊所、长期护理)、结构化和非结构化网络(例如，与导师/合作者的定期接触、出席会议、到开展平行研究的地点旅行)以及实施研究项目来实现。研究项目的目的是：(1)开发一种循证工具来测量辅助生活(AL)中精神卫生保健质量的设施水平指标；(2)使用该工具来量化随机抽样的ALS的质量指标；(3)评估非痴呆症特定护理区域(NDSCA)和痴呆症特定护理区域(DSCA)之间存在的质量指标的差异；以及(4)评估试点样本中质量指标与居民水平特征的关系，以确定未来R01应用的效果大小估计和方法。这些技能和经验的结合将使应聘者在多层次因素的背景下对精神卫生服务研究有深刻的理解。相关性：精神障碍在AL环境中非常普遍，并与许多不良后果相关，包括提前出院到疗养院和较差的生活质量。随着更多精神疾病发病率较高的老年人使用这种护理环境，人们对心理健康护理质量有很大的公共卫生担忧。这项拟议的研究既关键又及时，将为AL提供一种新的精神卫生保健质量工具，并提供关于是否存在基于证据的质量指标的经验数据。

DESCRIPTION (provided by applicant): This is an application for a K01 Mentored Research Scientist Career Development Award. The candidate is an epidemiological gerontologist who proposes to acquire specific skills and knowledge related to the field of health services research (HSR). The candidate's long-term career goal is to become a successful, highly productive independent investigator focusing on the epidemiology and care of mental health disorders for elders in multiple settings. Under the mentorship of Drs. P.V. Rabins and C.G. Lyketsos, and the supervision of Drs. S. Zimmerman, A. Rosenblatt, E. Stuart, N. Castle, M. Bruce, and L. Morgan, the candidate will carry out a 5-year career development plan. Short-term goals are to (1) gain practical field and leadership experience by conducting a prospective study focused on facility-level mental health care in assisted living; (2) enhance knowledge of HSR principles and methods and of elders' experiences in health care settings; (3) develop a solid knowledge base in principles of HSR instrument development; (4) foster independence for future work in mental health services research through interactions and collaborations with leaders in related fields; and (5) train in the conduct of responsible research. These goals will be accomplished through didactic training (e.g. 9 courses at the Johns Hopkins School of Public Health); clinical observation (e.g. geriatric psychiatry, ambulatory care outpatient clinics, long-term care); structured and unstructured networking (e.g., regular contact with the mentors/collaborators; conference attendance; travel to sites conducting parallel research); and carrying out a research project. The aims of research project are to: (1) develop an evidence-based instrument to measure facility-level indicators of mental health care quality in assisted living (AL); (2) use the instrument to quantify quality indicators in a random sample of ALs; (3) evaluate differences in the presence of quality indicators between non-dementia-specific care areas (NDSCAs) and dementia-specific care areas (DSCAs); and (4) evaluate the relationship of quality indicators with resident- level characteristics in a pilot sample to ascertain effect size estimates and methods for a future R01 application. Integration of these skills and experiences will provide the candidate with a deep understanding of mental health services research in the context of multi-level factors. RELEVANCE: Mental disorders are highly prevalent in the AL setting and are associated with a number of adverse outcomes including early discharge to nursing homes and poorer quality of life. As more elders with greater psychiatric morbidity utilize this care setting, there are significant public health concerns about mental health care quality. The proposed research is both critical and timely and will provide a new mental health care quality instrument for use in AL and empirical data on presence of evidenced-based quality indicators.