This application for a K23 Mentored Patient-Oriented Research Career Development Award will support critical additional training for the candidate, Dr. Christina Mangurian, a psychiatrist at the University of California, San Francisco (UCSF), based at San Francisco General Hospital. Dr. Mangurian's research plan focuses on improving metabolic screening among ethnically and racially diverse severely mentally ill populations served in community mental health clinics. To further develop her career as a mental health services researcher and to accomplish her research plan, she requires specific training in three areas: 1) clinical research methods (e.g., biostatistics, epidemiology, and mixed methods);2) implementation research;and 3) mental health disparities research. Dr. Mangurian has assembled a multidisciplinary team of mentors to facilitate her training and research. Her primary mentor is Dr. Dean Schillinger, a UCSF primary care internist with international expertise in primary care health services research, including implementation research in public health settings. He will oversee all training and research plans, providing his wealth of experience in this field, including his dedication to improving services for underserved populations. His expertise will be complemented by Dr. Martha Shumway, a UCSF mental health services researcher;and Dr. John Newcomer, a Washington University clinical investigator who is an expert in clinical and laboratory measurement of metabolic risk in severely mentally ill populations and in the translation of monitoring objectives into clinical practice. People with severe mental illness die, on average, 25 years earlier than the general population, most often from cardiovascular disease. Metabolic abnormalities (e.g., diabetes, hypertension, dyslipidemia) resulting from antipsychotic medications used to treat this population can lead to increased rates of cardiovascular disease. Despite national guidelines emphasizing the importance of screening, metabolic screening rates for this population remain low. There is an urgent need for evidence-based, generalizable interventions that can be feasibly implemented to improve metabolic screening at community mental health clinics where this vulnerable population is primarily served. Therefore, in Aim 1, Dr. Mangurian proposes to characterize metabolic screening rates among adults with severe mental illness who receive services at community mental health clinics in San Francisco County.
In Aim 2, she will tailor an intervention to improve metabolic screening for adults with severe mental illness by engaging multiple stakeholders and focusing on barriers that may impact high-risk racial/ethnic subpopulations.
In Aim 3, she will conduct a pilot study of the intervention. The results of this research will contribute new information about implementation efforts to improve metabolic screening in community mental health clinics and will form the basis of an R01 application to study the effectiveness of this intervention.

Public Health Relevance

The majority of people with severe mental illness are prescribed antipsychotic medications, many of which result in metabolic abnormalities (e.g., dyslipidemia, diabetes) and in turn increase cardiovascular risk. We will evaluate whether a pragmatic intervention - a mandatory annual metabolic screening visit by a psychiatrist, which is linked to a web-based electronic referral and clinical decision support tool - can be feasibly implemented at community mental health clinics to enhance early detection and treatment of metabolic disorders and thereby reduce the high prevalence of cardiovascular disease among people with severe mental illness.

National Institute of Health (NIH)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Mental Health Services in Non-Specialty Settings (SRNS)
Program Officer
Hill, Lauren D
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University of California San Francisco
Schools of Medicine
San Francisco
United States
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Trager, Evan; Khalili, Mandana; Masson, Carmen L et al. (2016) Hepatitis C Screening Rate Among Underserved Adults With Serious Mental Illness Receiving Care in California Community Mental Health Centers. Am J Public Health 106:740-2
Mangurian, Christina; Newcomer, John W; Modlin, Chelsea et al. (2016) Diabetes and Cardiovascular Care Among People with Severe Mental Illness: A Literature Review. J Gen Intern Med 31:1083-91
Mitsuishi, Fumi; Young, John Q; Leary, Mark et al. (2016) The Systems SOAP Note: A Systems Learning Tool. Acad Psychiatry 40:164-71
Cheng, Jason E; Shumway, Martha; Leary, Mark et al. (2016) Patient Factors Associated with Extended Length of Stay in the Psychiatric Inpatient Units of a Large Urban County Hospital. Community Ment Health J 52:658-61
Miner, Adam S; Milstein, Arnold; Schueller, Stephen et al. (2016) Smartphone-Based Conversational Agents and Responses to Questions About Mental Health, Interpersonal Violence, and Physical Health. JAMA Intern Med 176:619-25
Lee, Chuan Mei; Mangurian, Christina; Tieu, Lina et al. (2016) Childhood Adversities Associated with Poor Adult Mental Health Outcomes in Older Homeless Adults: Results From the HOPE HOME Study. Am J Geriatr Psychiatry :
Mangurian, Christina; Newcomer, John W; Vittinghoff, Eric et al. (2015) Diabetes Screening Among Underserved Adults With Severe Mental Illness Who Take Antipsychotic Medications. JAMA Intern Med 175:1977-9
Hermanstyne, Keith A; Mangurian, Christina (2015) Behavioral strategies to mitigate violent behavior among inpatients: a literature review. Psychiatr Serv 66:557-8
Mangurian, Christina; Shumway, Martha; Dilley, James (2014) Mental health services research training for the next generation of leaders in the public health sector: a case study of the UCSF/SFGH Public Psychiatry Fellowship. Acad Psychiatry 38:690-2
Steiner, Jeanne L; Giggie, Marisa A; Koh, Steve et al. (2014) The evolution of public psychiatry fellowships. Acad Psychiatry 38:685-9

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