This is an application for a K-08 Mentored Clinical Scientist Development Award on Variation and Appropriateness in Psychiatric Treatment Use. The applicant is a psychiatrist who seeks to become an independent investigator in mental health services research, focusing on: 1) geographic variations in the use of psychiatric treatments; 2) the appropriateness of psychiatric treatment use; and 3) methods of narrowing variations and improving the appropriateness of care. The career development plan is comprised of four components: 1) course work in economic and sociologic theory relevant to the utilization of mental health services; 2) course work in statistical and econometric analysis to allow the candidate to study clinical, economic and sociologic determinants of mental health care; 3) visiting preceptorships with experts in methods of assessing variation and appropriateness; and 4) supervised research experience under the mentorship of Harvard faculty in psychiatry, economics, and sociology.
The specific aims of the proposed research are:
Aim 1 : To analyze area variation in psychiatric treatment use among Medicare, Medicaid, and privately-insured beneficiaries. Diagnosis-specific utilization rates for psychotherapy, drug treatment, and electroconvulsive therapy (ECT) will be determined for geographic regions using claims from samples of Medicare, Medicaid, and private sector insurance beneficiaries. Potential determinants of variation, including clinical, economic, and sociologic factors, will be studied using multivariate models.
Aim 2 : To compare clinical indications for use of ECT with research findings regarding the efficacy of ECT. Medical records from a statewide sample of Massachusetts patients who have received ECT will be studied to determine the extent to which ECT is used appropriately. Clinical data from the medical records will be compared with criteria for appropriate use based on efficacy studies and the judgments of an expert panel. As cost-containment pressures increase, more attention is being drawn to the quality of psychiatric care. Narrowing variations in the utilization of mental health services and increasing the appropriate use of psychiatric treatments can help to maximize the clinical benefit derived from limited health care resources.
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