We propose a Private Sector Core, designed to develop research to increase our understanding, at an administrative and clinical level of detail, of the institutional policies and activities, at the level of plans, managed care companies, and medical practices, that shape management of care. Further, the Core seeks to understand clinician responses to these structural aspects of the managed care organizations in terms of ethical conflicts experienced and their possible resolutions, and clinician usual attitudes and practice style regarding persons with psychiatric disorders. Further, the Core addresses quality of care at the individual patient level, focusing especially on ethnic minorities as a population at risk for receiving a low quality of mental health care. Addressing issues which have remained largely unstudied previously, this Center Core relies substantially on qualitative research methods, conceptual and measurement development, and progressive refinement and applications of these new approaches across managed care organizations. The Core features four specific projects which directly enable this developmental approach, including case studies of organizational (institutional) policies and activities involved in managed care and potential impacts on practices; a philosophical analysis coupled with qualitative health services research methods to examine the ethical issues in managed mental health care; integration of previously tested approaches to conceptualize and measure clinician style in providing mental health care and participation in utilization management of activities, and adaptation of these methods for new studies of managed care for psychiatric disorders; and secondary data analyses on multiple aspects of quality of care for depressed minority populations, taking advantage of the clinically rich data from the Medical Outcomes Study (which had large minority samples) and a newly-funded NIMH study of quality improvement for depression in managed care. The Core investigators include a policy analyst, psychiatrists, a philosopher, an internist health services researcher, a social psychologist, participation of the Center PI, and consultation in statistical and qualitative research methods from the Interdisciplinary Methods Laboratory. The Core will publish methodological and substantive articles and a book, and develop new research proposals applying the approaches developed to studies of quality of care under alternative managed care structures, as well as intervention studies designed to improve quality of care, especially for minority populations, in private sector managed care for persons with psychiatric disorders.
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