Our long term research goal is to develop interventions that accelerate the adoption of evidence-based practices in rural areas and thereby reduce the burden of mental illness on rural children. Rural children experience mental illness at rates equivalent to urban children but live in a different social, cultural, and economic milieu. The nexus of these patient, community, clinician and health systems factors must be fully explored in order to understand the diffusion of evidence-based practices from urban to rural areas and among rural areas. Our rationale for these studies is that a better understanding of the locations in which innovations are adopted quickly or slowly would allow faster, more efficient information dissemination regarding new practices as well as promote innovative practice. There are two specific aims: (1) Develop a Geographic Information System (GIS) for identifying the locations of changes in prescribing for psychotropic medications. We will employ multi-level statistical models to determine the factors that are associated with the rate and locations of prescribing psychotropics to children. (2) Identify the mechanism of diffusion involved in the prescription of psychotropic medications to children. Our hypothesis is that information is transmitted through a social contagion process where early and late prescribers cluster geographically. Geographic information systems (GIS) and recent innovations in spatial statistics facilitate the modeling of complex diffusion processes. Prospective dissemination is made possible through """"""""syndromic surveillance"""""""" and the use of space-time cluster statistics. The approach permits us to study the development of diffusion clusters over time and the location-specific factors in their development. Our approach is innovative in that these methods are usually applied to arresting the spread of negative events (disease) rather than facilitating the spread of positive events such as growth in the adoption of evidence-based practices. This research is relevant to public health because the results will help in eliminating geographic disparities in mental health. The research will also deepen the understanding of rurality with respect to availability, access, need, and use of mental health services. ? ? ?
| Penfold, Robert B; Kelleher, Kelly J; Wang, Wei et al. (2010) Pediatric uptake of a newly available antipsychotic medication. Pediatrics 125:475-82 |
| Penfold, Robert B; Wang, Wei; Pajer, Kathleen et al. (2009) Spatio-temporal clusters of new psychotropic medications among Michigan children insured by Medicaid. Pharmacoepidemiol Drug Saf 18:531-9 |
