Impact of the Price of Gifts From Patients on Physicians' Service Quality in Online Consultations: Empirical Study Based on Social Exchange Theory.

BACKGROUND: Gift giving from patients to physicians, which is prohibited in traditional clinical settings in China, has been found to occur in online health communities. However, there is debate on the validity of online gifts since physicians gain an economic benefit. Moreover, the potential impact of these gifts, particularly with respect to the financial value of the gift, on the online consultation service quality remains unexplored. OBJECTIVE: The aim of this study was to explore the impact of gift price on the quality of physicians' online consultation service. Insight into this impact is expected to help resolve existing debate on the appropriateness of the gift-giving practice in online consultations. METHODS: A dataset of 141 physicians and 4249 physician-patient interactions was collected from the Good Physician Online website, which is the largest online consultation platform in China. Based on social exchange theory, we investigated how gift price affects the quality of physicians' online consultation service and how this impact changes according to the physician's service price and number of all gifts received. Manual annotation was used to identify the information support paragraphs and emotional support paragraphs in the answers of physicians. The quality of the information support paragraphs, rather than the complete answer, was used to test the robustness of our model. RESULTS: Gift price had a positive impact on the quality of physicians' online consultation service (ß=4.941, P<.01). This impact was negatively mediated by both the physician's service price (ß=-9.245, P<.001) and the total number of gifts they received (ß=-5.080, P<.001). CONCLUSIONS: Gift price has a positive impact on physicians' online behavior, although the impact varies among physicians.

How professional capital and team heterogeneity affect the demands of online team-based medical service.

BACKGROUND: The provision of medical services by Medical Teams (MT) on Online Healthcare Communities (OHCs) is a novel method employed by geographically-dispersed healthcare professionals to serve one patient simultaneously, allowing patients to receive more specific, targeted and comprehensive advice. As a relatively new method of service delivery, little attention has been paid to identifying the determinants of Team-based Service Demands (TSD). Based on Upper Echelons Theory and Social Exchange Theory, this study examines the impact of both professional capital (status capital and decisional capital) and team heterogeneity (team size and dispersion) on TSD. METHODS: This study uses data collected from 890 MTs, employing 3994 team members, operating on haodf.com , a Chinese OHC, to examine effects of both leader and team characteristics on TSD. RESULTS: Our findings suggest that a MT's characteristics have a significant impact on TSD. Firstly, the decisional capital of both leaders and teams were positively related with TSD, while only the status capital of leaders saw a positive impact. Secondly, team heterogeneity influenced TSD in two ways: (1) provided a direct negative impact and (2) positively moderated the relationship between professional capital and TSD. CONCLUSION: This paper comprehensively studies the impact of TSD from the perspectives of professional capital and team heterogeneity, expanding current theoretical understanding of team heterogeneity and social capital in OHCs. Further, it provides practical suggestions for platform development and team leaders managing MTs in online environments.

Population metrics for suicide events: A causal inference approach.

Large-scale public health prevention initiatives and interventions are a very important component to current public health strategies. But evaluating effects of such large-scale prevention/intervention faces a lot of challenges due to confounding effects and heterogeneity of study population. In this paper, we will develop metrics to assess the risk for suicide events based on causal inference framework when the study population is heterogeneous. The proposed metrics deal with the confounding effect by first estimating the risk of suicide events within each of the risk levels, number of prior attempts, and then taking a weighted sum of the conditional probabilities. The metrics provide unbiased estimates of the risk of suicide events. Simulation studies and a real data example will be used to demonstrate the proposed metrics.

Service provision, pricing, and patient satisfaction in online health communities.

Background The emergence of online health communities (OHCs) broadens and diversifies channels for patient-doctor interaction. In recent times, patient satisfaction has gained new attention within the context of OHCs where unique patterns are provided: a variety of services with unique attributes are available in OHCs for patients and doctors have the options of providing and pricing for different services. OHCs are given high hopes on improving medical efficiency and patient satisfaction. Knowing how these patterns in OHCs affect patient satisfaction is crucial for the development of OHCs and medical practices. METHODS: An empirical research is conducted to examine the effects of provision and pricing of online services on patient satisfaction by analyzing data from 2309 doctors in a Chinese OHC. RESULTS: The results from this study provided empirical support, suggesting that service quantity positively influenced patient satisfaction. A non-linear correlation between service price and satisfaction was explored and results suggested an inverted U-shaped relationship. At the low price level, service price led to an increase in patient satisfaction, whereas the high price level (over 330 CNY/US$49) could have just the opposite effect. Importantly, we found that price difference between a doctor's different services significantly decreased patient satisfaction. A mediating effect was tested in post-hoc analyses, and results revealed that the impact of price difference on patient satisfaction was partially mediated by flexibility of service selection, and the mediating effect accounted for 28.6% of the total effect. CONCLUSIONS: Our results indicate that patient satisfaction can be improved by effectively providing and pricing services in OHCs. Specifically, doctors can offer different type services and charge within a reasonable range.

Causal effects of informal care and health on falls and other accidents among the elderly population in China.

PURPOSE: This article analyzes the causal effects of informal care, mental health, and physical health on falls and other accidents (e.g., traffic accidents) among elderly people. We also examine if there are heterogeneous impacts on elderly of different gender, urban status, and past accident history. METHODS: To purge potential reversal causal effects, e.g., past accidents induce more future informal care, we use two-stage least squares to identify the impacts. We use longitudinal data from a representative national China Health and Retirement Longitudinal Study of people aged 45 and older in China. A total of 3935 respondents with two-wave data are included in our study. Each respondent is interviewed to measure health status and report their accident history. Mental health is assessed using CES-D questions. RESULTS: Our findings indicate that while informal care decreased the occurrence of accidents, poor health conditions increase the occurrence of accidents. We also find heterogeneous impacts on the occurrence of accidents, varying by gender, urban status, and past accident history. CONCLUSIONS: Our findings suggest the following three policy implications. First, policy makers who aim to decrease accidents should take informal care of elders into account. Second, ease of birth policy and postponed retirement policy are urgently needed to meet the demands of informal care. Third, medical policies should attach great importance not only to physical health but also mental health of elderly parents especially for older people with accident history.

Informal care and health behaviors among elderly people with chronic diseases.

BACKGROUND: The mechanism by which social relationships influence health can be interpreted as a social network regulating one's health behaviors. Based on the hypothesis that relatives, friends, or neighbors are sources of social support and may monitor one's health behaviors, researchers have gotten significant and consistent results that a social network can regulate health behaviors. However, few empirical studies have been conducted to examine the role of informal care in the regulation of health behaviors, especially for elderly individuals with chronic diseases that can be controlled by healthy behaviors. This paper researched the effects of informal care on health behaviors-smoking control, dietetic regulation, weight control, and maintenance of exercise-among elderly patients with chronic diseases in China who are facing the challenge of aging. METHODS: We used the propensity score matching method to control the impacts of a very rich set of family and individual characteristics. The 2011-2012 national baseline data of the China Health and Retirement Longitudinal Study (CHARLS) was used. RESULTS: Our findings showed that informal care could significantly help improve the health behaviors of elderly people. Informal care could improve the compliance of smoking control and dietetic regulation significantly. Elderly people with informal care smoked less and consumed more meals per day. For weight control, informal care helped decrease the possibility of weight gain of elderly people, but its impacts were not significant for BMI and weight loss. Last, for the elders, informal care could only help increase the probability of walking exercise; however, there was no significant result for moderate exercise. CONCLUSIONS: Findings from this study highlight the importance of informal care among elderly people. Our results appeal to policy makers who aim to control chronic diseases that they should take informal care into account and provide appropriate policies to meet the demand of informal care for elderly people.

Online written consultation, telephone consultation and offline appointment: An examination of the channel effect in online health communities.

INTRODUCTION: The emergence of online health communities broadens and diversifies channels for patient-doctor interaction. Given limited medical resources, online health communities aim to provide better treatment by decreasing medical costs, making full use of available resources and providing more diverse channels for patients. OBJECTIVES: This research examines how online channel usage affects offline channels, i.e., "Online Booking, Service in Hospitals" (OBSH), and how the channel effects change with doctors' online and offline reputation. METHODS: The study uses data of 4254 doctors from a Chinese online health community. RESULTS: Our findings demonstrate a strong relationship between online health communities and offline hospital communication with an important moderating role for reputation. There are significant channel effects, wherein written consultation complements OBSH (ß=3.320, p<0.10), but telephone consultation can be a readily substitute for OBSH (ß=-9.854, p<0.001). We also find that doctors with higher online and offline reputations can attract more patients to use the OBSH (ßonline=0.433, p<0.001; ßoffline=2.318&2.123, p<0.001). Third, channel effects fluctuate, relative to doctors' online and offline reputations: doctors with higher online reputations mitigate substitution effects between telephone consultation and OBSH (ß=0.064, p<0.01), and doctors with higher offline reputations mitigate complementary effects between written consultation and OBSH (ß=-1.586&-1.417, p<0.001). CONCLUSIONS: This study contributes to both knowledge and practice. This study shows that there is channel effect in healthcare, websites' managers can encourage physicians to provide online services, especially for these physicians who do not have enough patients.

A non-parametric model to address overdispersed count response in a longitudinal data setting with missingness.

Count responses are becoming increasingly important in biostatistical analysis because of the development of new biomedical techniques such as next-generation sequencing and digital polymerase chain reaction; a commonly met problem in modeling them with the popular Poisson model is overdispersion. Although it has been studied extensively for cross-sectional observations, addressing overdispersion for longitudinal data without parametric distributional assumptions remains challenging, especially with missing data. In this paper, we propose a method to detect overdispersion in repeated measures in a non-parametric manner by extending the Mann-Whitney-Wilcoxon rank sum test to longitudinal data. In addition, we also incorporate the inverse probability weighted method to address the data missingness. The proposed model is illustrated with both simulated and real study data.

Promoting Help Seeking to Veterans.

BACKGROUND: Few studies have considered different messaging strategies that may augment campaign efficacy to generate help-seeking behaviors among populations at increased risk for suicide, mainly US military veterans. AIMS: Findings are presented from the pilot evaluation of the It's Your Call campaign implemented by the Department of Veterans Affairs (VA). Three messaging strategies (with varying intensity and mix of messages) were compared to explore which best promote use of the Veterans Crisis Line (VCL) among veteran populations. METHOD: Daily VCL call data were obtained for 10 US cities during 2011-2012 where the campaign was active, and modeled using Poisson regression to identify changes in utilization patterns associated with the implementation of different messaging strategies. RESULTS: Significant increases in call rates were only evident during the campaign in communities where mixed messages were disseminated. Further, use of mixed messages yielded greater increases in call rates when compared with the other tested strategies. This was an observational study where identification of causal relationships between variables was limited. CONCLUSION: Findings are encouraging as messaging was associated with help seeking, and they provide insights into strategies that may rapidly promote crisis line use. Results also underscore the need for further research on suicide prevention campaigns and dissemination practices.

Exploring the impact of word-of-mouth about Physicians' service quality on patient choice based on online health communities.

BACKGROUND: Health care service is a high-credence service and patients may face difficulties ascertaining service quality in order to make choices about their available treatment options. Online health communities (OHCs) provide a convenient channel for patients to search for physicians' information, such as Word-of-Mouth (WOM), particularly on physicians' service quality evaluated by other patients. Existing studies from other service domains have proved that WOM impacts consumer choice. However, how patients make a choice based on physicians' WOM has not been studied, particularly with reference to different patient characteristics and by using real data. METHODS: One thousand eight hundred fifty three physicians' real data were collected from a Chinese online health community. The data were analyzed using ordinary least squares (OLS) method. RESULTS: The study found that functional quality negatively moderated the relationship between technical quality and patient choice, and disease risk moderated the relationship between physicians' service quality and patient choice. CONCLUSIONS: Our study recommends that hospital managers need to consider the roles of both technical quality and functional quality seriously. Physicians should improve their medical skills and bedside manners based on the severity and type of disease to provide better service.

A Simple Score Model to Assess Prediabetes Risk Status Based on the Medical Examination Data.

OBJECTIVES: We aimed to build a risk score model to screen out the patients at high-risk status so as to prevent or delay the conversion of prediabetes to diabetes. METHODS: The population were divided into 2 groups: 1 was an exploratory population, and the other was a validation population. All the data were extracted from the electronic medical examination datasets in the School Hospital of Harbin Institute of Technology, Harbin, China. A binary logistic regression model was used to screen out the risk factors, and the associated risk factors were categorized into 3 levels to create the prediabetes score model. We divided the total score into 4 risk categories: low, middle, high and extremely high risk. We also tested the performance of our prediabetes risk score model. RESULTS: Age, body mass indexes, histories of hypertension, family histories of diabetes, diastolic blood pressure levels and triglyceride levels were screened out as independent risk factors in order to build the risk score model. The area under the curve (AUC) of the prediabetes risk score model was 0.748 (95% CI, 0.720 to 0.777), and the AUC for the validation population reached 0.713 (95% CI, 0.686 to 0.740). Low, middle, high and extremely high risk statuses for prediabetes were associated with a total score of 0 to 3, 4 to 6, 7 to 10 and 11 to 12. CONCLUSIONS: Our prediabetes score model can be used easily and understood by doctors and other related users to assess prediabetes risk status. The intervention program, designed based on our prediabetes score model, is likely to prevent or delay the conversion of prediabetes to diabetes.

Measuring Associations of the Department of Veterans Affairs' Suicide Prevention Campaign on the Use of Crisis Support Services.

Campaigns have become popular in public health approaches to suicide prevention; however, limited empirical investigation of their impact on behavior has been conducted. To address this gap, utilization patterns of crisis support services associated with the Department of Veterans Affairs' Veterans Crisis Line (VCL) suicide prevention campaign were examined. Daily call data for the National Suicide Prevention Lifeline, VCL, and 1-800-SUICIDE were modeled using a novel semi-varying coefficient method. Analyses reveal significant increases in call volume to both targeted and broad resources during the campaign. Findings underscore the need for further research to refine measurement of the effects of these suicide prevention efforts.

Two Studies of Connectedness to Parents and Suicidal Thoughts and Behavior in Children and Adolescents.

We tested hypotheses that greater connectedness to parent(s) is associated with lower risk for nonlethal suicidal thoughts and behavior (STB), termed direct protective effects, and that parent connectedness serves to moderate (lower) the risk for STB associated with psychopathology including major depressive episode (MDE), termed moderating protective effects. Independent samples of children and adolescents recruited for a multicenter study of familial alcoholism were studied. Generalized estimating equation models were used that adjusted for age, sex, and youth psychopathology variables. The sample for Study 1 was assessed at baseline and about 2- and 4-year follow-ups, with baseline characteristics of n = 921, M age = 14.3 ± 1.8 years, and 51.8% female. The sample for Study 2 was assessed at baseline and about 5-year follow-up, with baseline characteristics of n = 867, M age = 12.0 ± 3.2 years, and 51.0% female. In both studies, increased perceived connectedness to father but not mother was associated with lower risk for measures of STB, consistent with direct protective effects. In Study 1, measures of parent connectedness were associated with lower risk for STB but only for youth that did not experience MDE (or alcohol use disorder), inconsistent with moderating protective effects. Study 2 showed that connectedness to fathers was associated with lower risk for suicide plans or attempts (severe STB) but not frequent thoughts of death or dying (nonsevere STB). Improved connectedness to fathers may lower risk for STB in children and adolescents, consistent with direct protective effects. Hypotheses about moderating protective effects were not supported.

Depression care management for adults older than 60 years in primary care clinics in urban China: a cluster-randomised trial.

BACKGROUND: China's national health policy classifies depression as a chronic disease that should be managed in primary care settings. In some high-income countries use of chronic disease management principles and primary care-based collaborative-care models have improved outcomes for late-life depression; however, this approach has not yet been tested in China. We aimed to assess whether use of a collaborative-care depression care management (DCM) intervention could improve outcomes for Chinese adults with depression aged 60 years and older. METHODS: Between Jan 17, 2011, [corrected] and Nov 30, 2013, we did a cluster-randomised trial in patients from primary care centre clinics in Shangcheng district of Hangzhou city in eastern China. We randomly assigned (1:1) clinics to either DCM (involving training for physicians in use of treatment guidelines, training for primary care nurses to function as care managers, and consultation with psychiatrists as support) or to give enhanced care as usual to all eligible patients aged 60 years and older with major depressive disorder. Clinics were chosen randomly for inclusion from all primary care clinics in the district by computer algorithm and then randomly allocated depression care interventions remotely by computer algorithm. Physicians, study personnel, and patients were not masked to clinic assignment. Our primary outcome was difference in Hamilton Depression Rating Scale (HAMD) score using data for clusters at baseline and 3, 6, and 12 month follow-up in a mixed-effects model of the intention-to-treat population. We originally aimed to analyse outcomes at 24 months, however the difference between groups at 12 months was large and funding was insufficient to continue to 24 months, therefore we decided to end the trial at 12 months. This trial is registered with ClinicalTrials.gov, number NCT01287494. FINDINGS: Of 34 primary care clinics in Shangcheng district, 16 were randomly chosen. We randomly assigned eight clinics to the DCM intervention (164 patients enrolled) and eight primary care clinics to enhanced care as usual (162 patients). There were no major differences in baseline demographic and clinical variables between the groups of patients for each intervention. Over the 12 months, patients in clinics assigned to DCM had a significantly greater reduction in HAMD score than did those in practices assigned to enhanced care as usual (estimated between group difference -6·5 [95% CI -7·1 to -5·9]; Cohen's d 0·8 [95% CI 0·8-0·9]; p<0·0001). The intercluster correlation for change in HAMD total score was 0·07 (95% CI 0·06-0·08). There were no study-related adverse events in either group. INTERPRETATION: Clinical outcomes of Chinese adults older than 60 years who had major depression were improved when their primary care clinic used DCM. Primary care-based collaborative management of depression is promising to address this pressing public health need in China. FUNDING: National Institutes of Health, Program for New Century Excellent Talents in Universities of China, Ministry of Education, China.

On performance of parametric and distribution-free models for zero-inflated and over-dispersed count responses.

Zero-inflated Poisson (ZIP) and negative binomial (ZINB) models are widely used to model zero-inflated count responses. These models extend the Poisson and negative binomial (NB) to address excessive zeros in the count response. By adding a degenerate distribution centered at 0 and interpreting it as describing a non-risk group in the population, the ZIP (ZINB) models a two-component population mixture. As in applications of Poisson and NB, the key difference between ZIP and ZINB is the allowance for overdispersion by the ZINB in its NB component in modeling the count response for the at-risk group. Overdispersion arising in practice too often does not follow the NB, and applications of ZINB to such data yield invalid inference. If sources of overdispersion are known, other parametric models may be used to directly model the overdispersion. Such models too are subject to assumed distributions. Further, this approach may not be applicable if information about the sources of overdispersion is unavailable. In this paper, we propose a distribution-free alternative and compare its performance with these popular parametric models as well as a moment-based approach proposed by Yu et al. [Statistics in Medicine 2013; 32: 2390-2405]. Like the generalized estimating equations, the proposed approach requires no elaborate distribution assumptions. Compared with the approach of Yu et al., it is more robust to overdispersed zero-inflated responses. We illustrate our approach with both simulated and real study data.

Associations between the Department of Veterans Affairs' suicide prevention campaign and calls to related crisis lines.

OBJECTIVE: The Transit Authority Suicide Prevention (TASP) campaign was launched by the Department of Veterans Affairs (VA) in a limited number of U.S. cities to promote the use of crisis lines among veterans of military service. METHODS: We obtained the daily number of calls to the VCL and National Suicide Prevention Lifeline (NSPL) for six implementation cities (where the campaign was active) and four control cities (where there was no TASP campaign messaging) for a 14-month period. To identify changes in call volume associated with campaign implementation, VCL and NSPL daily call counts for three time periods of equal length (pre-campaign, during campaign, and post-campaign) were modeled using a Poisson log-linear regression with inference based on the generalized estimating equations. RESULTS: Statistically significant increases in calls to both the VCL and the NSPL were reported during the TASP campaign in implementation cities, but were not reported in control cities during or following the campaign. Secondary outcome measures were also reported for the VCL and included the percentage of callers who are veterans, and calls resulting in a rescue during the study period. CONCLUSIONS: Results from this study reveal some promise for suicide prevention messaging to promote the use of telephone crisis services and contribute to an emerging area of research examining the effects of campaigns on help seeking.

Randomized controlled trial of interpersonal psychotherapy versus enhanced treatment as usual for women with co-occurring depression and pelvic pain.

OBJECTIVE: Our study assessed the effectiveness of Interpersonal Psychotherapy (IPT) tailored for biomedical patients with depression and pain. IPT was compared to enhanced treatment as usual (E-TAU) among women with co-occurring depression and chronic pain presenting for care at a women's health or family medicine practice. We hypothesized that women presenting to urban medical practices with depression and chronic pain would benefit from IPT tailored to address their needs to a greater degree than from E-TAU. METHODS: We conducted a randomized controlled psychotherapy trial of 61 women from 2 urban medical practices who met criteria for major depressive disorder and chronic pelvic pain. Participants were assigned to receive either 8 sessions of IPT or a facilitated psychotherapy referral to a community mental health center, and assessed for depression, social interactions, and pain at 0-, 12-, 24-, and 36-weeks, with score on the Hamilton Rating Scale for Depression as the primary outcome. Both intent-to-treat (ITT) and causal modeling analyses correcting for treatment attendance were conducted. RESULTS: ITT analyses were not significant. In causal modeling analyses, participants assigned to IPT showed significantly more improvement for depression and social interactions, but not for pain. CONCLUSION: IPT may be a viable option as part of a comprehensive treatment program for women in medical practices with depression and chronic pain. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov, NCT00895999.

Log-transformation and its implications for data analysis.

SUMMARY: The log-transformation is widely used in biomedical and psychosocial research to deal with skewed data. This paper highlights serious problems in this classic approach for dealing with skewed data. Despite the common belief that the log transformation can decrease the variability of data and make data conform more closely to the normal distribution, this is usually not the case. Moreover, the results of standard statistical tests performed on log-transformed data are often not relevant for the original, non-transformed data.We demonstrate these problems by presenting examples that use simulated data. We conclude that if used at all, data transformations must be applied very cautiously. We recommend that in most circumstances researchers abandon these traditional methods of dealing with skewed data and, instead, use newer analytic methods that are not dependent on the distribution the data, such as generalized estimating equations (GEE).

Posttraumatic stress disorder and suicide in 5.9 million individuals receiving care in the veterans health administration health system.

BACKGROUND: Post-traumatic stress disorder (PTSD) confers risk for suicidal ideation and suicide attempts but a link with suicide is not yet established. Prior analyses of users of the Veterans health administration (VHA) Health System suggest that other mental disorders strongly influence the association between PTSD and suicide in this population. We examined the association between PTSD and suicide in VHA users, with a focus on the influence of other mental disorders. METHODS: Data were based on linkage of VA National Patient Care Database records and the Centers for Disease Control and Prevention׳s National Death Index, with data from fiscal year 2007-2008. Analyses were based on multivariate logistic regression and structural equation models. RESULTS: Among users of VHA services studied (N=5,913,648), 0.6% (N=3620) died by suicide, including 423 who had had been diagnosed with PTSD. In unadjusted analysis, PTSD was associated with increased risk for suicide, with odds ratio, OR (95% confidence interval, 95% CI)=1.34 (1.21, 1.48). Similar results were obtained after adjustment for demographic variables and veteran characteristics. After adjustment for multiple other mental disorder diagnoses, PTSD was associated with decreased risk for suicide, OR (95% CI)=0.77 (0.69, 0.86). Major depressive disorder (MDD) had the largest influence on the association between PTSD and suicide. LIMITATIONS: The analyses were cross-sectional. VHA users were studied, with unclear relevance to other populations. CONCLUSION: The findings suggest the importance of identifying and treating comorbid MDD and other mental disorders in VHA users diagnosed with PTSD in suicide prevention efforts.

Examining Benefits of Academic-Community Research Team Training: Rochester's Suicide Prevention Training Institutes.

BACKGROUND: Although community-engaged research (CER), including community-based participatory research (CBPR), is a growing approach in addressing health disparities, little scientific study on how to enhance its processes or products exists. These fields are built on practice-based case studies, evaluations, and qualitative examinations of principles in action. This gap is as an emerging priority in the clinical and translation sciences. OBJECTIVES: We designed a 5-day workshop for academic-community research teams in suicide prevention and health promotion, broadly defined. Seasoned academic and community partners developed and implemented curriculum at three training institutes from 2007 to 2010. We developed self-report tools to evaluate this training model for CER practice. We crafted and evaluated both mediating processes and outcome measures for academic and community partners to assess team CER development. METHODS: We analyzed post-training evaluation surveys completed late in 2010. We conducted exploratory factor analysis on survey data from 48 community or academic partners. These team members participated in at least one National Institutes of Health-funded CER training institute to advance suicide prevention, broadly defined. CONCLUSIONS: Partnership development measures that capture both academic and community perspectives demonstrate reliability and validity. Multidimensional latent constructs for inclusion in CER development models included partnership agency, personal knowledge and capacities, and benefits of collaborative research partnerships over time. We discuss the utility of findings to future CER training design and study.