Over a period of years, I've begun to master decision and cost-effectiveness analysis techniques, allowing me to embark on several primary care infectious disease projects as a sidelight to significant responsibilities in clinical, educational, and administrative roles. To become an independent, rigorous researcher, I need more thorough research training and the release from other duties that a K23 award allows. The centerpiece of career development activities will be the K30 supported Clinical Research Training Program at the University of Pittsburgh, providing necessary background in clinical research fundamentals and formal training in biostatistics, decision sciences, medical economics, and database analysis. Along with this program, my primary mentor, Mark S. Roberts, MD, MPP, an expert in medical decision sciences, will continue our long-term research and educational collaboration. Roberta Ness, MD, MPH will act as co-mentor, providing expertise on women's health and sexually transmitted disease epidemiology and, as the principal investigator of the PID Evaluation and Clinical Health (PEACH) Study, access to data on the evaluation, treatment, and costs of pelvic inflammatory disease. Other advisors will add expertise in patient preference assessment, sexually transmitted disease prevention and treatment, simulation modeling techniques, and medical economics. My project will be the development of a clinically realistic simulation model of PID, using primarily collected patient utility data as well as data from the PEACH Study and other sources. Optimal care of women with PID will be modeled by synthesis of available data, capturing the tension between evidence-based best practice, patient preferences for therapeutic options and health states, and the costs of PID and its complications. The model will also allow examination of subgroups with different risk profiles and of the impact of preventive measures on PID incidence, complications, and costs. Using the model, we expect to explore questions that clinical trials are not well suited to answer regarding optimal PID management in different risk subgroups, timing of PID preventive strategies, and the impact of different screening methods and strategies on clinical outcomes and costs.