Assessment of modifications to evidence-based psychotherapies using administrative and chart note data from the US department of veterans affairs health care system.
Assessment of modifications to evidence-based psychotherapies using administrative and chart note data from the US department of veterans affairs health care system.
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DOI：
10.3389/fpubh.2022.984505
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发表时间：
2022
影响因子：
5.2
通讯作者：
Sayer, Nina A.
中科院分区：
文献类型：
--
作者：
Wiltsey Stirman, Shannon;La Bash, Heidi;Nelson, David;Orazem, Robert;Klein, Abigail;Sayer, Nina A.
美国退伍军人事务部(VA)在提供循证心理疗法(EBPS)方面拥有超过15年的经验。本文描述了使用临床文献和管理数据来了解创伤后应激障碍(PTSD)患者对EBPS的依从性和修改的策略。本研究以认知加工疗法(CPT)和长期暴露疗法(PE)为研究对象，对两种治疗创伤后应激障碍的EBPS进行了研究。样本包括来自美国各地的VA治疗师，他们提供CPT和PE，以及他们在一年内治疗的患者。这项研究的数据来源是模板化的EBP图表注释和退伍军人管理局管理数据。我们使用对笔记内容和管理数据规则的手动审查，在182名治疗师看过的1257名患者的7297次EBP会议中编码治疗依从性和修改。两名训练有素的编码员对每个治疗笔记进行评分，并通过协商一致解决差异。为了说明和解释依从性和修复性的差异，我们对这些治疗师(n=32)进行了简短的30-45分钟的半结构化访谈。结合手工图表审查和管理数据，可确定11种修改类型。评分者对30%的音符坚持意见不一。分歧源于没有明确记录的治疗修改的存在，需要制定修改编码的决策规则和策略。治疗师和患者都导致了不同修改发生的程度的差异。治疗师访谈表明，治疗师意识到通过回顾图表确定的方式修改方案。医疗保健系统可以使用收集的数据作为常规护理的一部分，以了解EBP如何以及何时被修改，但需要制定可扩展的战略，以记录对常规护理中EBP的适应和修改。
The US Department of Veterans Affairs (VA) has over 15 years of experience in delivery of evidence-based psychotherapies (EBPs). This paper describes strategies for using clinical documentation and administrative data to understand adherence and modifications to EBPs for Posttraumatic Stress Disorder (PTSD). This study focused on two EBPs for PTSD, Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). The sample included VA therapists from across the US who provided CPT and PE and the patients they treated over a 1-year period. The data sources for this study were templated EBP chart notes and VA administrative data. We used a manual review of note content and administrative data rules to code therapy adherence and modifications in 7,297 EBP sessions for 1,257 patients seen by 182 therapists. Two trained coders rated each therapy note and resolved discrepancies through consensus. To contextualize and explain variation in adherence and modifications, we conducted brief 30–45-min semi-structured interviews with a purposive subsample of these therapists (n = 32). Combining manual chart review and administrative data allowed for identification of 11 types of modifications. Raters disagreed on adherence for 30% of notes. The disagreement stemmed from the presence of therapy modifications that were not clearly documented, necessitating the development of decision rules and strategies for modification coding. Both therapists and patients contributed to the variance in the extent to which different modifications occurred. Therapist interviews demonstrated therapist awareness of modifying the protocols in the ways identified through chart review. Healthcare systems can use data collected as part of routine care to understand how and when EBPs are modified but need to develop scalable strategies to document adaptations and modifications to EBPs in routine care.
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影响因子：
3.3
作者：
Cook, Joan M.;Dinnen, Stephanie;Schnurr, Paula P.
通讯作者：
Schnurr, Paula P.
影响因子：
13.8
作者：
Schnurr PP;Chard KM;Ruzek JI;Chow BK;Resick PA;Foa EB;Marx BP;Friedman MJ;Bovin MJ;Caudle KL;Castillo D;Curry KT;Hollifield M;Huang GD;Chee CL;Astin MC;Dickstein B;Renner K;Clancy CP;Collie C;Maieritsch K;Bailey S;Thompson K;Messina M;Franklin L;Lindley S;Kattar K;Luedtke B;Romesser J;McQuaid J;Sylvers P;Varkovitzky R;Davis L;MacVicar D;Shih MC
通讯作者：
Shih MC
影响因子：
5.9
作者：
Yu SH;Brookman-Frazee L;Kim JJ;Barnett ML;Wright B;Lau AS
通讯作者：
Lau AS
影响因子：
7.2
作者：
Stirman, Shannon Wiltsey;Baumann, Ana A.;Miller, Christopher J.
通讯作者：
Miller, Christopher J.
影响因子：
3.8
作者：
Gross, Georgina M.;Smith, Noelle;Harpaz-Rotem, Ilan
通讯作者：
Harpaz-Rotem, Ilan