The proposed study regarding the impact of my primary care psychiatry clinic with respect to effectiveness, utilization of services, cost of care, and patient satisfaction will help develop my abilities to perform mental health services research. I will develop skills in research design, using research instruments, administering research data analysis, and writing grants and articles for publication. I will have the help of the following mentors: Joel Yager, M.D., Samuel J. Keith, M.D., Eberhard Ulenhuth, M.D., statisticians and research design experts employed by the core grant, and external consultants including Drs. Kenneth Wells and Spero Manson. The study will test the hypotheses that 1) patients with serious and persistent psychiatric mental disorders enrolled in the Albuquerque VAMC Psychiatry Primary Care Clinic (PPC), a single clinic which provides both psychiatry and primary care, require less inpatient psychiatric and inpatient medical care, will have fewer ER visits, medical sub-specialty visits, numbers and total costs of medication prescriptions, numbers and total costs of outpatient laboratory tests, less overall cost of care, miss fewer clinical visits and have greater satisfaction with their care than these same patients did while being followed for a comparable period of time in a traditional manner in the internal medicine and psychiatry clinics at the Albuquerque VAMC; 2) that these patients also require less of these sorts of care, lower costs, miss fewer visits, and have greater satisfaction than a comparable group of patients followed in separate primary care and psychiatry clinics during the same periods of time at the Tucson VAMC; and 3) that the factors related to effectiveness, utilization, cost and satisfaction with care will differ by ethnic group. Data will be obtained for the two year time periods just prior to and just following the inception of the PPC from the Abuquerque and Tucson VAMCs, the later chosen because it lacks a PPC. Samples of at least 170 patients each in Albuquerque and Tucson for the analysis.
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