Different people respond differently to therapy: A demonstration using patient profiling and risk stratification
Different people respond differently to therapy: A demonstration using patient profiling and risk stratification
复制标题
DOI：
10.1016/j.brat.2016.02.003
复制
发表时间：
2016-04-01
影响因子：
4.1
通讯作者：
Lutz, Wolfgang
中科院分区：
文献类型：
--
作者：
Delgadillo, Jaime;Moreea, Omar;Lutz, Wolfgang
背景：本研究旨在确定与心理治疗不良结果相关的患者特征，并开发患者分析方法。方法：对 1347 名门诊患者的临床评估数据进行分析。最终治疗结果基于抑郁 (PHQ-9) 和焦虑 (GAD-7) 测量的可靠且临床显着改善 (RCSI)。在交叉验证设计中使用逻辑回归探索了 13 名患者特征作为潜在的结果预测因素。结果：残疾、就业状况、年龄、功能障碍、基线抑郁和结果预期预测治疗后 RCSI。这些因素的回归系数用于得出称为利兹风险指数（LRI）的加权方案，用于为个别案例分配风险评分。将病例分为三个 LRI 评分水平后，我们发现 RCSI 和治疗完成率存在显着差异。此外，LRI 评分与被归类为“不正常”的治疗疗程比例显着相关。结论：LRI 工具可以识别有进展不良风险的病例，为低强度和高强度心理干预提供个性化治疗建议。 (C) 2016 Elsevier Ltd. 保留所有权利。
Background: This study aimed to identify patient characteristics associated with poor outcomes in psychological therapy, and to develop a patient profiling method.Method: Clinical assessment data for 1347 outpatients was analysed. Final treatment outcome was based on reliable and clinically significant improvement (RCSI) in depression (PHQ-9) and anxiety (GAD-7) measures. Thirteen patient characteristics were explored as potential outcome predictors using logistic regression in a cross-validation design.Results: Disability, employment status, age, functional impairment, baseline depression and outcome expectancy predicted post-treatment RCSI. Regression coefficients for these factors were used to derive a weighting scheme called Leeds Risk Index (LRI), used to assign risk scores to individual cases. After stratifying cases into three levels of LRI scores, we found significant differences in RCSI and treatment completion rates. Furthermore, LRI scores were significantly correlated with the proportion of treatment sessions classified as 'not on track'.Conclusions: The LRI tool can identify cases at risk of poor progress to inform personalized treatment recommendations for low and high intensity psychological interventions. (C) 2016 Elsevier Ltd. All rights reserved.