Optimizing treatment response in VA Specialized Intensive/Inpatient PTSD programs

优化 VA 专业重症/住院 PTSD 项目的治疗反应

• 批准号: 10209946
• 负责人: Rebecca Kaufman Sripada
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10209946
• 关键词: Address; Administrator; Affect; Area; Budgets; Caring; Clinical; Cognition; Cost Analysis; Data; Data Collection; Diagnosis; Disease; Economic Burden; Economics; Enrollment; Environment; Event; Evidence based practice; Evidence based treatment; Foundations; Future; Goals; Health; Health Policy; Health Services; Health Services Research; Health system; Individual; Inpatients; Institute of Medicine (U.S.); Institutes; Intensive Care; Intervention; Interview; Investments; Life; Measures; Mental Health; Mental Health Services; Mentorship; Methods; Michigan; Monitor; Moods; Outcome; Outpatients; Participant; Patients; Performance; Persons; Post-Traumatic Stress Disorders; Prediction of Response to Therapy; Process; Program Evaluation; Provider; Psychiatry; Public Health Schools; Qualitative Methods; Quality of Care; Reporting; Research; Research Activity; Research Methodology; Research Personnel; Residential Treatment; Resources; Risk; Site; Social support; Standardization; Substance abuse problem; Symptoms; Techniques; Testing; Theoretical model; Time; Training; Training Activity; Training Support; Trauma; Treatment outcome; Universities; Veterans; analytical method; base; care costs; chronic pain; comorbidity; cost; design; efficacy testing; evidence base; experience; feasibility testing; high risk; hospital readmission; implementation cost; implementation science; improved; improved outcome; innovation; interest; motivational enhancement therapy; multilevel analysis; personalized approach; point of care; predicting response; program costs; programs; psychologic; response; service intervention; skills; social; social factors; theories; treatment optimization; treatment response; treatment services

Background: Posttraumatic Stress Disorder (PTSD) affects approximately 23% of returning Veterans and produces significant psychological, physical, and economic burdens. Although most Veterans with PTSD are treated on an outpatient basis, the VA has 39 Specialized Intensive/Inpatient PTSD programs (SIPPs) designed to treat high-needs Veterans who require more intensive and closely monitored care. The treatment of patients enrolled in SIPPs is extremely costly; only 1% of VA patients with a PTSD diagnosis enroll in SIPPs but they account for 33% of VA's budget for specialized PTSD care. Furthermore, despite these costs, many patients undergoing treatment in SIPPs may experience only modest improvements in PTSD symptoms. Thus, the Institute of Medicine has recently called for strategies to improve treatment outcomes of VA PTSD treatment in general and residential programs specifically, making it clear the VA needs to carefully assess and address poor treatment response among Veterans receiving residential and other PTSD treatment. Objectives: The goal of this CDA is to optimize PTSD care by identifying individual- and program-level factors associated with poor treatment response in residential programs, which will greatly enhance the VA's ability to target and improve treatment approaches for these high-need, high-cost individuals. Aim 1 will identify individual- and program-level predictors of treatment response in residential programs nationwide. Aim 2 will further elucidate factors associated with poor PTSD treatment response, using a qualitative approach with patient, provider, and administrator interviews at a VISN 10 program and nationally at 3 high-performing and 3 low-performing programs (based on average symptom change and percent of patients readmitted within 14 days of discharge). Aim 3 will pilot an adaptation of an existing treatment or health services intervention based on findings from the initial study aims, data on treatment practices at high-performing sites, and assessment of feasibility from an expert panel consisting of the mentorship team, operational partners, and frontline staff. Methods: This research will be guided by the theory of Resources, Life Events and Changes in Psychological States. Aim 1 will assess predictors of poor response using multilevel modeling of nationwide clinical information collected by the Northeast Program Evaluation Center. Variables of interest will include individual- level resources and factors such as comorbidities, social contextual resources (e.g. low social support), and program resources such the availability of evidence-based treatments. Aim 2 will utilize qualitative analytic methods to assess individual and program-level predictors of response by interviewing patients and providers. Aim 3 will consist of a feasibility pilot conducted with 60 patients at a VISN 10 residential program for PTSD. Candidate: The PI's long-term goal is to become an independent VA health services investigator who develops and evaluates programs to improve outcomes for individuals with severe and difficult-to-treat PTSD and improve care quality for PTSD. During this CDA, the PI will build the foundation of a research program focusing on poor PTSD treatment response while building expertise in health services methods. The PI will complete training activities in: (1) multilevel modeling, program evaluation, and other health services methods, (2) qualitative and mixed methods, and (3) Implementation Science and cost analysis. The proposed research and training activities will provide the PI with the skills to inform improved PTSD care for Veterans. Environment: The PI will benefit from the wealth of resources supporting training and research that are available through the VA HSR&D Center of Innovation, the University of Michigan Department of Psychiatry, the Institute for Healthcare Policy and Innovation, and the School of Public Health. She will make full use of these opportunities and the supportive and coordinated mentorship team to enrich her current and proposed research. The proposed CDA research is highly significant and addresses key VA and ORD priority areas including mental health services research and advancing Point of Care Research in PTSD.

背景：创伤后应激障碍 (PTSD) 影响大约 23% 的退伍军人和 造成严重的心理、身体和经济负担。尽管大多数患有创伤后应激障碍 (PTSD) 的退伍军人 VA 提供 39 个门诊治疗的专业强化/住院 PTSD 项目 (SIPP) 旨在治疗需要更密集和密切监测护理的高需求退伍军人。治疗 参加 SIPP 的患者费用极其昂贵；只有 1% 诊断为 PTSD 的 VA 患者参加 SIPP 但他们占 VA 专门 PTSD 护理预算的 33%。此外，尽管有这些成本，许多 接受 SIPP 治疗的患者的 PTSD 症状可能仅略有改善。因此， 医学研究所最近呼吁采取策略来改善 VA PTSD 的治疗结果 一般治疗和具体的住宿计划，明确 VA 需要仔细评估和 解决接受住院治疗和其他创伤后应激障碍治疗的退伍军人治疗反应不佳的问题。 目标：该 CDA 的目标是通过识别个人和项目层面的因素来优化 PTSD 护理 与住院计划中治疗反应不佳有关，这将大大增强 VA 的能力 针对这些高需求、高成本的人群制定并改进治疗方法。目标 1 将确定 全国住院项目治疗反应的个人和项目水平预测因素。目标2将 使用定性方法进一步阐明与 PTSD 治疗反应不佳相关的因素 在 VISN 10 计划以及全国 3 个高绩效项目和 3 个项目中对患者、提供者和管理人员进行访谈 表现不佳的项目（基于平均症状变化和 14 年内重新入院的患者百分比） 出院天数）。目标 3 将试行基于现有治疗或卫生服务干预措施的调整 根据初步研究目标的结果、高绩效场所治疗实践的数据以及对 由导师团队、运营合作伙伴和一线员工组成的专家小组提出可行性建议。 方法：本研究将以资源、生活事件和心理变化理论为指导。 国家。目标 1 将使用全国临床的多级模型来评估反应不良的预测因素 信息由东北项目评估中心收集。感兴趣的变量将包括个人- 水平资源和因素，例如合并症、社会背景资源（例如社会支持低），以及 计划资源，例如循证治疗的可用性。目标 2 将利用定性分析 通过采访患者和提供者来评估个人和项目层面的反应预测因素的方法。 目标 3 将包括在 VISN 10 创伤后应激障碍 (PTSD) 住院项目中对 60 名患者进行可行性试点。 候选人：PI 的长期目标是成为一名独立的 VA 卫生服务调查员， 制定和评估计划，以改善患有严重且难以治疗的创伤后应激障碍（PTSD）患者的结果 并提高 PTSD 的护理质量。在此 CDA 期间，PI 将建立研究计划的基础 重点关注创伤后应激障碍（PTSD）治疗效果不佳的问题，同时建立卫生服务方法方面的专业知识。 PI 将 完成以下方面的培训活动：(1) 多层次建模、项目评估和其他卫生服务方法， (2) 定性和混合方法，以及 (3) 实施科学和成本分析。拟议的研究 培训活动将为 PI 提供改善退伍军人创伤后应激障碍 (PTSD) 护理的技能。 环境：PI 将受益于支持培训和研究的丰富资源 可通过 VA HSR&D 创新中心、密歇根大学精神病学系获得， 医疗保健政策与创新研究所和公共卫生学院。她将充分利用 这些机会以及支持和协调的指导团队丰富了她当前和拟议的 研究。拟议的 CDA 研究非常重要，涉及 VA 和 ORD 的关键优先领域 包括心理健康服务研究和推进创伤后应激障碍 (PTSD) 护理点研究。

项目成果

The Association Between Service Connection and Treatment Outcome in Veterans Undergoing Residential PTSD Treatment.

接受住院 PTSD 治疗的退伍军人的服务连接与治疗结果之间的关联。

• 发表时间: 2022
• 作者: Rodriguez, Jessica L;Hale, Andrew C;Marston, Holloway N;Sage;Wright, Theodore P;Driesenga, Scott A;Martin, Shannon M;Sripada, Rebecca K
• 通讯作者: Sripada, Rebecca K

"I wish people could come together like we have," patient and provider perspectives on VA residential PTSD treatment.

“我希望人们能够像我们一样团结起来”，患者和提供者对 VA 住院 PTSD 治疗的看法。

• 发表时间: 2023-11
• 影响因子: 2.3
• 作者: Sripada, Rebecca K;Walters, Heather M
• 通讯作者: Walters, Heather M

Changes in Salivary Cortisol During Psychotherapy for Posttraumatic Stress Disorder: A Pilot Study in 30 Veterans.

创伤后应激障碍心理治疗期间唾液皮质醇的变化：针对 30 名退伍军人的初步研究。

• 发表时间: 2017-05
• 作者: Rauch, Sheila A M;King, Anthony P;Liberzon, Israel;Sripada, Rebecca K
• 通讯作者: Sripada, Rebecca K

Mental Health Service Utilization before and after Receipt of a Service-Connected Disability Award for PTSD: Findings from a National Sample.

获得 PTSD 服务相关残疾奖前后的心理健康服务利用情况：全国样本的调查结果。

• 发表时间: 2018
• 影响因子: 3.4
• 作者: Sripada, Rebecca K;Hannemann, Claire M;Schnurr, Paula P;Marx, Brian P;Pollack, Stacey J;McCarthy, John F
• 通讯作者: McCarthy, John F

Examining the nonresponse phenomenon: Factors associated with treatment response in a national sample of veterans undergoing residential PTSD treatment.

检查无反应现象：与接受住院 PTSD 治疗的退伍军人全国样本中的治疗反应相关的因素。

• 发表时间: 2019
• 影响因子: 10.3
• 作者: Sripada, Rebecca K;Blow, Frederic C;Rauch, Sheila A M;Ganoczy, Dara;Hoff, Rani;Harpaz;Bohnert, Kipling M
• 通讯作者: Bohnert, Kipling M