Leveraging available metadata in VA PTSD clinics and generating benchmarks for clinically significant change.
Leveraging available metadata in VA PTSD clinics and generating benchmarks for clinically significant change.
复制标题
利用 VA PTSD 诊所的可用元数据并为临床重大变化生成基准。
DOI：
10.1037/ccp0000779
复制
发表时间：
2023
影响因子：
5.9
通讯作者：
Litz,BrettT
中科院分区：
文献类型：
--
作者：
Benfer,Natasha;Rusowicz-Orazem,Luke;Fielstein,ElliotM;Darnell,BenjaminC;Frankfurt,SheilaB;Mignogna,Joseph;Litz,BrettT
基于测量的护理旨在跟踪治疗期间的症状水平，并利用临床显著变化基准来提高质量和结果。虽然退伍军人健康管理局促进监测创伤后应激障碍（PTSD）临床团队的进展，但由于缺乏基于人口的临床显著变化基准，数据的可操作性降低。我们报告了创伤后应激障碍临床团队中重复测量的状态，生成基准，并根据这些基准检查结果。第五版数据是从COVID-19前一年的企业数据仓库中挑选出来的，用于在14周内接受至少8次培训的退伍军人（护理事件[EOC]队列）和接受零星护理的人群（模式队列）。我们使用Jacobson和Truax（1991）方法在临床、区域和国家层面生成临床显著变化基准，并使用我们生成的基准和最近一项研究的基准计算恶化、不变、改善或可能恢复的病例频率，两个cohols.ResultsBoth重复测量的数量和谁在企业数据仓库中的多期护理的情况下是非常低的。临床显著变化基准在不同地方水平相似。模态队列有更差的结果比EOC cohol.ConclusionsNational基准的临床显著变化可以提高actionability的评估数据为基础的护理措施。使用接受多次护理的退伍军人的数据创建的基准比接受零星护理的结果更好。PTSD临床团队中基于测量的护理受到结果重复评估率低的阻碍。
ObjectiveMeasurement-based care is designed to track symptom levels during treatment and leverage clinically significant change benchmarks to improve quality and outcomes. Though the Veterans Health Administration promotes monitoring progress within posttraumatic stress disorder (PTSD) clinical teams, actionability of data is diminished by a lack of population-based benchmarks for clinically significant change. We reported the state of repeated measurement within PTSD clinical teams, generated benchmarks, and examined outcomes based on these benchmarks.MethodPTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition data were culled from the Corporate Data Warehouse from the pre-COVID-19 year for Veterans who received at least eight sessions in 14 weeks (episode of care [EOC] cohort) and those who received sporadic care (modal cohort). We used the Jacobson and Truax (1991) approach to generate clinically significant change benchmarks at clinic, regional, and national levels and calculated the frequency of cases that deteriorated, were unchanged, improved, or probably recovered, using our generated benchmarks and benchmarks from a recent study, for both cohorts.ResultsBoth the number of repeated measurements and the cases who had multisession care in the Corporate Data Warehouse were very low. Clinically significant change benchmarks were similar across locality levels. The modal cohort had worse outcomes than the EOC cohort.ConclusionsNational benchmarks for clinically significant change could improve the actionability of assessment data for measurement-based care. Benchmarks created using data from Veterans who received multisession care had better outcomes than those receiving sporadic care. Measurement-based care in PTSD clinical teams is hampered by low rates of repeated assessments of outcome.