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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
1K23MH093689-01A1
Application #
8241654
Study Section
Mental Health Services in Non-Specialty Settings (SRNS)
Program Officer
Hill, Lauren D
Project Start
2012-08-16
Project End
2017-07-31
Budget Start
2012-08-16
Budget End
2013-07-31
Support Year
1
Fiscal Year
2012
Total Cost
$177,687
Indirect Cost
$13,162
Name
University of California San Francisco
Department
Psychiatry
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Shumway, Martha; Mangurian, Christina; Carraher, Noah et al. (2018) Increasing HIV Testing in Inpatient Psychiatry. Psychosomatics 59:186-192
Mangurian, Christina; Modlin, Chelsea; Williams, Lindsey et al. (2018) A Doctor is in the House: Stakeholder Focus Groups About Expanded Scope of Practice of Community Psychiatrists. Community Ment Health J 54:507-513
Mangurian, Christina V; Schillinger, Dean; Newcomer, John W et al. (2018) Diabetes and Prediabetes Prevalence by Race and Ethnicity Among People With Severe Mental Illness. Diabetes Care 41:e119-e120
Mangurian, Christina; Packman, Wendy; Riano, Nicholas S et al. (2018) The need to support caregivers during pediatric bone marrow transplantation (BMT): A case report. Palliat Support Care 16:367-370
Mangurian, Christina; Scalchunes, Christopher; Yoo, Jennie et al. (2018) Psychosocial services for primary immunodeficiency disorder families during hematopoietic cell transplantation: A descriptive study. Palliat Support Care :1-6
Mangurian, Christina; Niu, Grace C; Schillinger, Dean et al. (2017) Utilization of the Behavior Change Wheel framework to develop a model to improve cardiometabolic screening for people with severe mental illness. Implement Sci 12:134
Lee, Chuan Mei; Mangurian, Christina; Tieu, Lina et al. (2017) Childhood Adversities Associated with Poor Adult Mental Health Outcomes in Older Homeless Adults: Results From the HOPE HOME Study. Am J Geriatr Psychiatry 25:107-117
Mangurian, Christina; Cournos, Francine; Schillinger, Dean et al. (2017) Low Rates of HIV Testing Among Adults With Severe Mental Illness Receiving Care in Community Mental Health Settings. Psychiatr Serv 68:443-448
Mangurian, Christina; Riano, Nicholas S; Newcomer, John W (2017) First-Episode Schizophrenia and Diabetes Risk. JAMA Psychiatry 74:761-762
Garcia, Maria E; Schillinger, Dean; Vittinghoff, Eric et al. (2017) Nonpsychiatric Outpatient Care for Adults With Serious Mental Illness in California: Who Is Being Left Behind? Psychiatr Serv 68:689-695

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