This application's primary purpose is to provide the candidate with the means and mentorship to achieve the following goals: 1) Immediate goal: to characterize the effect of healthcare financing structure on utilization and quality of primary care services for patients with depression. 2) Long-term goals: to become an independent health services researcher, investigating policy-relevant questions about the effects of insurance structure on care for the chronically ill. The candidate will further develop and utilize research skills in health economics and psychiatric outcomes assessment; develop facility in techniques to analyze the effects of financial and organizational incentives; and acquire advanced training in quality of care measurement. He will master disease-specific skills in mental health services research by working on a multidisciplinary team studying a patient-oriented mental health intervention in a primary care setting. The career development program will incorporate formal coursework; tutorials and workshops with experts in specific methodological issues; site visits to major venues studying mental health services; and attendance and research presentations at local and national conferences. The major goal of the proposed research program is to characterize the effect of insurance structure on utilization and quality of primary care services for patients with depression. This goal will be accomplished through the planning, conduct, and analysis of a research project using data from a study that focuses on treatment for geriatric patients with depression. This study, a five-year multi-site NIMH-funded clinical intervention trial (Charles F. Reynolds, III, P.I., Prevention of Suicide in Older Primary Care: Patients [PROSPECT], is investigating strategies to improve depression treatment in primary care settings. The proposed K23 research will describe the effects of insurance structure on: individual patients' ambulatory service utilization, and the quality of care for depression. In addition, the research will assess the effect of insurance on the intervention to improve depression treatment in a primary care setting. Furthermore, this study will implement, collect, and predictably validate quality of care performance measures for several domains of depression management.
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