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Improving Primary Care Management of Complex Patients with Psychiatric Illness

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Dr. Danielle Loeb's overarching career goal is to improve clinical outcomes for complex patients with psychiatric illness treated in the primary care setting. The proposed research develops and pilots a tailored practice facilitation (TPF) intervention designed to increase primary care physician (PCP) self-efficacy to deliver effective team-based care for this population. Candidate: Dr. Loeb is an Assistant Professor of Medicine in the Division of General Internal Medicine at the University of Colorado Anschutz Medical Campus. She works closely with her primary mentor and co-mentors; Drs. Frank deGruy, Elizabeth Bayliss, Ingrid Binswanger, Donald Nease, and Evette Ludman. She has published three manuscripts on complex patients with psychiatric illness with a members of this team and has a manuscript on the implementation of a depression screening and treatment protocol under review. Training: The proposed K23 career development plan builds on her fellowship training and early career development to focus on two areas that require additional training: 1) survey design and 2) dissemination and implementation of behavioral health research. Dr. Loeb proposes intensive topical mentorship, focused coursework, seminars, and contextual learning through the proposed research. Mentors/Environment: The environment for this project is outstanding, and Dr. Loeb will draw on her senior research mentors' expertise in psychiatric illness in primary care (Dr. Frank deGruy), complex patients (Dr. Elizabeth Bayliss), dissemination and implementation science research (Dr. Nease), behavioral health (Dr. Ludman), biostatistics (Dr. Miriam Dickinson), survey methodology (Dr. Lori Crane), and the responsible conduct of research (Binswanger). Research: There is a pressing need to improve the care of complex patients with psychiatric illness, as they have a high risk of poor quality of life, high medical costs, poor outcomes, and high mortality rates. This study will produce results of direct relevance to PCPs working in clinical practice. The PCP survey in Aim 1 builds on Dr. Loeb's prior qualitative research and will provide key information regarding the factors influencing PCP self- efficacy and engagement in team-based care for complex patients with psychiatric illness. With the help of an internationally renowned expert panel, in Aim 2 we will develop a Tailored Practice Facilitation (TPF) intervention. In Aim 3 we will pilot the TPF intervention in an internal medicine clinic. Summary: This innovative project will use a tailored practice facilitation intervention to increase the self- efficacy of PCPs treating complex patients with psychiatric illness in a team-based model of care. Conduct of this mentored research and training proposal, Improving primary care management of complex patients with psychiatric illness, will facilitate Dr. Loeb's development into an independent investigator and leader conducting research to improve the care of complex patients with psychiatric illness in the primary care setting.
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