This is a proposal for a Research Scientist Award for Dr. Kenneth Wells. The research plan is based on Donabedian's model of the components of quality of care (structure, process, outcomes), as applied to individuals with affective disorders or other serious psychiatric illness. The research focuses on improving definitions and measures of quality and outcomes of care and identifying sources of variation in quality and outcomes of care, but particularly effects of alternative strategies to finance mental health care under prepaid and managed care arrangements. The research will be pursued through a variety of research activities including studying and refining existing measures, analyzing existing data bases from previously funded grants, and developing new studies of variations in quality and outcomes of care. This work involves development of a joint research program at RAND and UCLA, and incorporation of new research perspectives (for example, ethnographic methods to further develop the concept of functional status outcomes). An additional research goal is to identify strategies to improve quality of care for patients with affective and other serious psychiatric disorders, focusing on interventions, such as continuous quality improvement and approaches based on social influences theory, that are designed to alter the structure and clinical operations of practice environments. This work will be accomplished through collaboration with a newly funded Center for Changing Provider Behavior at the Sepulveda Veterans Administration Hospital, and applying these approaches to psychiatric conditions. Science education, in particular mentoring of junior clinical investigators, in mental health services research is also a major aim of the proposed RSA.
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