This is a competing continuation for an NIMH R01 (Pathways to Outcomes of Care in Depression), which funded five-year follow-up of participants in Partners in Care, a group-level randomized trial of quality improvement interventions versus usual care for depression. Our continuation proposes a new follow-up study in response to key findings from the existing grant: 1) Quality improvement interventions for depression had stronger effects on improving outcomes among minorities than whites during the active intervention period, despite similar effects on quality of care across ethnic groups; 2) by five-year follow-up, ethnic-related health outcome disparities apparent among controls were eliminated among intervention subjects. We propose a 3-stage study of quality improvement (QI) effects on health outcome disparities: 1) Stage 1: 7-year follow-up of the full PIC sample (N=1182) to examine how initial QI affected intermediate outcomes such as concerns about stigma of depression; occurrence of life events; use of social supports; having a regular provider; use of appropriate treatments. 2) Stage 2: a qualitative study of the minority subjects, using a series of telephone interviews, to examine how subjects respond to depressive symptoms, stressful life events, and healthcare visits, in real time. 3) Stage 3: an ethnographically-based further follow-up of Latinos in Los Angeles, stratified by gender, intervention status and 7-year outcome, to learn more about how depressed patients are managing their lives within the context of their own environment. Data from Stage 1 will be used to test hypotheses about QI effects on intermediate outcomes and differences in such effects for minorities and whites; data from Stages 2 and 3 will be used to confirm or refute findings from Stage 1, provide richer detail on pathways to outcome improvement, and generate hypotheses about mechanisms for outcome improvement among minorities. The continuation application uses mixed methods and the investigators are an interdisciplinary team of clinicians, anthropologists, sociologists, statisticians, and cultural experts. ? ? ?
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