The proposed Health Services Research Center(HSRC) will conduct interdisciplinary research on critical issues of health services for chronic drug users (CDUs). The organizing theme is the integration of multidisciplinary research for effective utilization of personnel, data, and facilities to achieve optimum benefits for science, the center, and the community itself. Two foci of the center's theme are community and chronic drug users. A base of center-experienced multidisciplinary faculty and staff and an existing dynamic, supportive and collaborative environment will permit rapid expansion and development of the proposed HSRC, its administrative/shared resource core and three research components. The HSRC core will: 1) provide scientific leadership, thematic focus, and organizational foundation to develop, promote, support and sustain the center; 2) organize the center to support specific investigations that are consistent with a central yet sufficiently broad theme and generate optimum scientific and center benefits; 3) stimulate a synergism, with co resources as catalysts, that includes community linkages, individual research endeavors, and leadership for health services research field; 4) supply technology, specialized spatial analytic methods, and data to address health services questions by incorporating geographic, demographic, and ecological perspectives; 5) ensure that data are captured, managed, and analyzed in HSRC studies to expeditiously address research questions and are readily accessible for continued and secondary analyses; 6) incorporate qualitative methods in center studies and include qualitative research training for investigators and staff; 7) add training on health services research involving CDUs to existing training resources; 8) enhance continuing and stimulate new intramural and extramural research collaborations; 9) use high-technology communications tools for rapid and widespread access to and dissemination of the latest research findings; and 10) sustain high levels of research and publications productivity an,,d quality, and develop improved technologies to transfer findings to researchers, providers, and consumers. The theme encompasses questions about the organization of health care resources of Dade County, Florida, how the services system identifies, assesses and serves CDUs; CDUs' perceptions of their health care needs, how they use the existing system, barriers to access, and CDU's responses; and variability in health care access and effectiveness by ethnicity and gender. These questions are addressed by three coordinated, interrelated and interactive research components: 1) structured interviews with a stratified sample of 1800 CDUs from representative health districts, selected by GIS analysis, regarding their health care utilization experiences and records' reviews in agencies they report having used; 2) analysis of available health service resources in the geographic context of estimated populations of CDUs and interviews with health service personnel in a population-based sample of agencies' regarding their agencies policies and practices re: services to CDUs; and, 3) design and implementation of an intervention project using knowledge gained from the first two projects and targeting and randomizing subjects enrolled from project 1, investigating for effectiveness in achieving the intermediate goal of improved access/utilization and in promoting health and associated functioning, including reduced drug use and health outcomes.
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