Remember the denominator: improving population impact of translational behavioral research

Freed, Michael

doi:10.1093/tbm/ibz184

Cited by 2 publications

(2 citation statements)

References 25 publications

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“…n P = .04. meta-analysis 25 identified stepped care collaborative care interventions as the optimal treatment approach for injured trauma survivors compared with cognitive behavioral therapy alone, 87 because stepped care approaches combine effective evidence-based interventions with expanded breadth of applicability, resulting in greater overall population impact. [88][89][90] The present trial extends these earlier observations by demonstrating that a brief collaborative care intervention can be feasibly delivered by front-line trauma center clinicians and is effective when well implemented. Two recent investigations that used brief sessionbased cognitive behavioral therapy delivered by mental health specialty 35 and front-line acute care 30 clinicians found no PTSD treatment effects.…”

Section: Discussionsupporting

confidence: 61%

“…Collaborative care broadens the reach of mental health treatment for injury survivors by combining evidence-based PTSD pharmacotherapy and behavioral intervention elements with proactive injury case management. A recent meta-analysis identified stepped care collaborative care interventions as the optimal treatment approach for injured trauma survivors compared with cognitive behavioral therapy alone, because stepped care approaches combine effective evidence-based interventions with expanded breadth of applicability, resulting in greater overall population impact . The present trial extends these earlier observations by demonstrating that a brief collaborative care intervention can be feasibly delivered by front-line trauma center clinicians and is effective when well implemented.…”

Section: Resultssupporting

confidence: 51%

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Stepped Collaborative Care Targeting Posttraumatic Stress Disorder Symptoms and Comorbidity for US Trauma Care Systems

et al. 2021

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ImportanceTo date, few multisite investigations have evaluated early interventions for injured patients with posttraumatic stress disorder (PTSD) symptoms.ObjectiveTo simultaneously assess the effectiveness and implementation of a brief stepped collaborative care intervention targeting PTSD and comorbidity.Design, Setting, and ParticipantsA stepped-wedge cluster randomized clinical trial was conducted at 25 US level I trauma centers. Participants included hospitalized survivors of physical injury who underwent a 2-step evaluation for PTSD symptoms. Patients reporting high levels of distress on the PTSD Checklist (PCL-C) were randomized (N = 635) per the stepped-wedge protocol to enhanced usual care control (n = 370) or intervention (n = 265) conditions. The study was conducted from January 4, 2016, through November 2019. Data analysis was performed from November 4, 2019, to December 8, 2020.InterventionsThe Trauma Survivors Outcomes and Support collaborative care intervention included proactive injury case management that assisted patients transitioning from hospital inpatient to outpatient and community settings. The intervention also integrated evidence-based pharmacotherapy and psychotherapeutic elements targeting PTSD symptoms and comorbidity.Main Outcomes and MeasuresThe primary study outcome was PTSD symptoms assessed with the PCL-C at baseline in the surgical ward and at 3, 6, and 12 months postinjury. Secondary outcomes included depressive symptoms, alcohol use, and physical function. Subgroup analyses examined the effect of baseline risk factors for enduring PTSD and quality of protocol implementation on study outcomes. Primary statistical analyses were conducted using the intent-to-treat sample.ResultsA total of 327 men (51.5%) were included in analysis; mean (SD) age was 39.0 (14.2) years. The investigation attained follow-up of 75% to 80% of the participants at 3 to 12 months. The intervention lasted a mean (SD) of 122 (132) minutes. Mixed model regression analyses revealed statistically significant changes in PCL-C scores for intervention patients compared with control patients at 6 months (difference, −2.57; 95% CI, −5.12 to −0.03; effect size, 0.18; P &lt; .05) but not 12 months (difference, −1.27; 95% CI, −4.26 to 1.73; effect size, 0.08; P = .35). Subgroup analyses revealed larger PTSD treatment effects for patients with 3 or more baseline risk factors for enduring PTSD and for patients, including firearm injury survivors, treated at trauma centers with good or excellent protocol implementation. Intervention effects for secondary outcomes did not attain statistical significance.Conclusions and RelevanceA brief stepped collaborative care intervention was associated with significant 6-month but not 12-month PTSD symptom reductions. Greater baseline PTSD risk and good or excellent trauma center protocol implementation were associated with larger PTSD treatment effects. Orchestrated efforts targeting policy and funding should systematically incorporate the study findings into national trauma center requirements and verification criteria.Trial RegistrationClinicalTrials.gov Identifier: NCT02655354

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