This is a request for a competing renewal for an NIMH Midcareer Investigator Award in Patient-Oriented Research. This grant builds on Dr. Katon's extensive research in developing cost-effective interventions to improve the quality of care and outcomes for patients with major depression and panic disorder within primary care systems, and to improve understanding about the prevalence and impact of depressive and anxiety disorders in patients with comorbid medical disorders such as diabetes. The grant also builds on Dr. Katon's experience over two decades in successfully mentoring junior investigators to become independent researchers, including his 15 years of experience as Director of an NIMH T32 NRSA Primary Care-Psychiatry Fellowship. This K24 will enhance Dr. Katon's expertise in epidemiology, biostatistics, health economics and disease management, which will improve his ability to mentor junior colleagues as well as to carry out the patient-oriented research proposed in his current NIMH R01 and other ongoing and new research proposals. The three specific career goals that will be met by the K24 are: 1) To demonstrate in population-based studies the impact of depressive and anxiety disorders in patients with chronic medical illness. The evidence from the population-based studies will be developed in two ways: a) epidemiologic data showing the cross-sectional and longitudinal effect of depression/anxiety on symptom burden, functioning, quality of life, self-care, medical costs and medical outcomes; and b) intervention studies demonstrating that improved quality of care and outcomes of depression in patients with chronic illness results in decreased symptom burden, improved functioning and quality of life, improved self-care and improved disease outcomes (such as HbA1c) at reasonable costs; 2) To continue to disseminate collaborative models of care by: a) expanding evidence of this model's cost-effectiveness in improving outcomes of elderly, underserved populations, and patients with anxiety disorders; b) expanding the evidence that these models have a significant impact on policy-relevant outcomes such as days off work and cut down days at reasonable medical costs; c) developing a fidelity measure of program implementation of collaborative care that can test which components of collaborative care are most important in improving outcomes; and d) developing evidence-based quality of care guidelines for optimizing depression outcomes for HEDIS performance measures; and 3) To continue to expand Dr. Katon's mentorship of junior investigators involved in mental health services research. These goals will be met through continued and expanded research activities, graduate-level coursework in epidemiology, health services, health management, biostatistics and health economics at the University of Washington School of Public Health and mentorship from external consultants. These courses will improve Dr. Katon's ability as a mentor as well as enhancing the proposed cutting-edge research activities in cost-effectiveness analysis, meta-analysis, measuring indirect costs (work productivity and absenteeism), development of a fidelity measure of collaborative care and an enhanced understanding of organizational and regulatory issues in disseminating collaborative care models. A K24 at this stage of the applicant's career will provide release from administrative responsibilities and provide the time and resources needed to capitalize on an excellent network of senior investigators who will provide mentoring and potential collaborative research opportunities. ? ?
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