This study will examine access and quality in geriatric depression care, and identify disparities and the factors that lead to them, building knowledge of care processes that is needed to improve care and reduce disparities. We will integrate analyses from multiple CMS datasets including the Medicare Current Beneficiary Survey (MCBS), Medicare claims-files, and merged Medicare-Medicaid data on dual eligibles to provide a comprehensive picture of patterns and trends in depression care among the U.S. elderly, with a focus on the role of Medicare, and on variations in quality of care. We will analyze predictors and trends in depression care among the elderly through 2004 and examine predictors and trends in duration, intensity and guideline consistency of treatment received. We will examine in detail use, type and duration of mental health services; duration of antidepressant use; and expenditures and payer sources for depression care. Disparities in receipt and quality of care will be examined with the aim of identifying the processes that lead to disparities and policy-modifiable barriers that can be addressed to reduce disparities. We will examine how the incidence, length of stay, cost and predictors of hospitalizations for depression have changed as outpatient treatment has increased; the predictors of appropriate outpatient treatment and specialty mental health care use preceding and following the hospitalization; and patterns of rehospitalization. Implications for Medicare policy will be examined. The understanding of depression care for the elderly Medicare population that will be provided by these analyses will be particularly important in a period in which many changes to Medicare, such as prescription drug benefits, are being implemented and others are being debated. [unreadable] [unreadable]