Large randomized clinical trials on quality improvement initiatives have produced modest or temporary effects on improving depression care in primary care. Accordingly, there are increased calls for services researchers to question and challenge the approaches used to improve the quality of care for people with mental illnesses. While economic incentives have long been documented to affect physicians' behavior, scant attention has been paid to the alignment of payment incentives with quality improvement. The candidate proposes to integrate the theories and methods from economics and communications research to address how to align payment incentives with quality improvement in the daily practice of mental health treatment in primary care. The applicant requests 5 years of funding through the K01 program to carry out an intensive supervised training and research program including direct observation of mental health treatment in a wide range of clinical settings plus additional training in decision theory and communications research. The training program aims to enhance understanding of how various dynamic professional and economic factors affect physicians' decision-making. The research program will develop a heuristic dynamic economic model of physicians' decision-making and test it with two conceptually linked pilot studies. The first pilot will survey about 500 primary care physicians with vignettes designed to assess knowledge of clinical guidelines on depression treatment and to appraise potential impact of payment change on quality of care. The second study will collect a panel of patient-physician interaction data augmented with patient and physician surveys from about 100 primary care patients for 2 years. Empirical analyses will use structural equation models with categorical dependent variables and latent explanatory variables. Regular meetings will be held with mentors and other advisors to ensure an intensive supervised training and research experience. Such an experience will enable the applicant to use an interdisciplinary approach in a larger future study on how to alter incentives to promote patient-centered mental health treatment process.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01MH001935-02
Application #
6653890
Study Section
Special Emphasis Panel (ZMH1-SRV-C (01))
Program Officer
Rupp, Agnes
Project Start
2002-09-01
Project End
2007-08-31
Budget Start
2003-09-01
Budget End
2004-08-31
Support Year
2
Fiscal Year
2003
Total Cost
$146,018
Indirect Cost
Name
Texas A&M University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
141582986
City
College Station
State
TX
Country
United States
Zip Code
77845
Tai-Seale, Ming; Stults, Cheryl; Zhang, Weimin et al. (2012) Expressing uncertainty in clinical interactions between physicians and older patients: what matters? Patient Educ Couns 86:322-8
Tai-Seale, Ming; McGuire, Thomas (2012) Time is up: increasing shadow price of time in primary-care office visits. Health Econ 21:457-76
Tai-Seale, Ming; Bolin, Jane; Bao, Xiaoming et al. (2011) Management of chronic pain among older patients: inside primary care in the US. Eur J Pain 15:1087.e1-8
Vannoy, Steven D; Tai-Seale, Ming; Duberstein, Paul et al. (2011) Now what should I do? Primary care physicians' responses to older adults expressing thoughts of suicide. J Gen Intern Med 26:1005-11
Tai-Seale, Ming; McGuire, Thomas G; Zhang, Weimin (2007) Time allocation in primary care office visits. Health Serv Res 42:1871-94
Tai-Seale, Ming; McGuire, Thomas; Colenda, Christopher et al. (2007) Two-minute mental health care for elderly patients: inside primary care visits. J Am Geriatr Soc 55:1903-11
Tai-Seale, Ming; Bramson, Rachel; Drukker, David et al. (2005) Understanding primary care physicians' propensity to assess elderly patients for depression using interaction and survey data. Med Care 43:1217-24
Tai-Seale, Ming (2004) Voting with their feet: patient exit and intergroup differences in propensity for switching usual source of care. J Health Polit Policy Law 29:491-514