Effectiveness and comparative effectiveness of evidence-based psychotherapies for posttraumatic stress disorder in clinical practice

Maguen, Shira; Madden, Erin; Holder, Nicholas; Li, Yongmei; Seal, Karen H.; Neylan, Thomas C.; Lujan, Callan; Patterson, Olga V.; DuVall, Scott L.; Shiner, Brian

doi:10.1017/s0033291721001628

Cited by 21 publications

(36 citation statements)

References 42 publications

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“…There are some advantages to using formats other than MHA to administer PROMs, such as being able to easily divide clinical and administrative tasks (which can be cumbersome using MHA), 25 as well as allowing patients to complete the assessment prior to the clinic visit 40 . To abstract this information from clinical note text, we employed a previously developed algorithm built using the same cohort and NLP platform used for development of the EBP algorithm, which has a 98% precision in accurately identifying mentions of PCL scores 26 . For this application, we used the same set of TIU documents associated with mental health visits described above.…”

Section: Methodsmentioning

confidence: 99%

“…40 To abstract this information from clinical note text, we employed a previously developed algorithm built using the same cohort and NLP platform used for development of the EBP algorithm, which has a 98% precision in accurately identifying mentions of PCL scores. 26 For this application, we used the same set of TIU documents associated with mental health visits described above. We discarded all scores outside of the appropriate range for each version of the PCL.…”

Section: Detection Of Pcl Scores Using Nlpmentioning

confidence: 99%

“…26 Fortunately, information on EBP for PTSD receipt as well as PCL data can be also be accurately captured from free text clinical notes using natural language processing (NLP). 26 Therefore, our objective was to measure the quality of EBP for PTSD and associated MBC over time using structured VA EMR data and to determine the effect of supplementing that measurement with additional data derived from NLP. Our hope was that these combined analyses would both provide an indication of the extent to which structured data can capture the quality of VA care for PTSD and provide a more accurate estimate of changes to quality over time.…”

Section: Introductionmentioning

confidence: 99%

“…While it is possible that these therapists were overestimating their use of EBP for PTSD, it is also possible that the templates were not used in all cases and that therapists documented PE or CPT sessions using free text notes instead. In another study measuring improvement from EBP for PTSD in routine practice, approximately a third of known PCL scores were recorded in free text clinical notes, but not in structured PCL data 26 . Fortunately, information on EBP for PTSD receipt as well as PCL data can be also be accurately captured from free text clinical notes using natural language processing (NLP) 26 .…”

Section: Introductionmentioning

confidence: 99%

“…In another study measuring improvement from EBP for PTSD in routine practice, approximately a third of known PCL scores were recorded in free text clinical notes, but not in structured PCL data 26 . Fortunately, information on EBP for PTSD receipt as well as PCL data can be also be accurately captured from free text clinical notes using natural language processing (NLP) 26 . Therefore, our objective was to measure the quality of EBP for PTSD and associated MBC over time using structured VA EMR data and to determine the effect of supplementing that measurement with additional data derived from NLP.…”

Section: Introductionmentioning

confidence: 99%

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Improvements to PTSD quality metrics with natural language processing

Shiner

Levis

Dufort

et al. 2021

Evaluation Clinical Practice

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Rationale aims and objectives As quality measurement becomes increasingly reliant on the availability of structured electronic medical record (EMR) data, clinicians are asked to perform documentation using tools that facilitate data capture. These tools may not be available, feasible, or acceptable in all clinical scenarios. Alternative methods of assessment, including natural language processing (NLP) of clinical notes, may improve the completeness of quality measurement in real‐world practice. Our objective was to measure the quality of care for a set of evidence‐based practices using structured EMR data alone, and then supplement those measures with additional data derived from NLP. Method As a case example, we studied the quality of care for posttraumatic stress disorder (PTSD) in the United States Department of Veterans Affairs (VA) over a 20‐year period. We measured two aspects of PTSD care, including delivery of evidence‐based psychotherapy (EBP) and associated use of measurement‐based care (MBC), using structured EMR data. We then recalculated these measures using additional data derived from NLP of clinical note text. Results There were 2 098 389 VA patients with a diagnosis of PTSD between 2000 and 2019, 72% (n = 1 515 345) of whom had not previously received EBP for PTSD and were treated after a 2015 mandate to document EBP using templates that generate structured EMR data. Using structured EMR data, we determined that 3.2% (n = 48 004) of those patients met our EBP for PTSD quality standard between 2015 and 2019, and 48.1% (n = 23 088) received associated MBC. With the addition of NLP‐derived data, estimates increased to 4.1% (n = 62 789) and 58.0% (n = 36 435), respectively. Conclusion Healthcare quality data can be significantly improved by supplementing structured EMR data with NLP‐derived data. By using NLP, health systems may be able to fill the gaps in documentation when structured tools are not yet available or there are barriers to using them in clinical practice.

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Section: Methodsmentioning

confidence: 99%

Section: Detection Of Pcl Scores Using Nlpmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Improvements to PTSD quality metrics with natural language processing

Shiner

Levis

Dufort

et al. 2021

Evaluation Clinical Practice

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Reporting of Observational Studies Explicitly Aiming to Emulate Randomized Trials

Hansford,

Cashin,

Jones

et al. 2023

JAMA Netw Open

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ImportanceObservational (nonexperimental) studies that aim to emulate a randomized trial (ie, the target trial) are increasingly informing medical and policy decision-making, but it is unclear how these studies are reported in the literature. Consistent reporting is essential for quality appraisal, evidence synthesis, and translation of evidence to policy and practice.ObjectiveTo assess the reporting of observational studies that explicitly aimed to emulate a target trial.Evidence ReviewWe searched Medline, Embase, PsycINFO, and Web of Science for observational studies published between March 2012 and October 2022 that explicitly aimed to emulate a target trial of a health or medical intervention. Two reviewers double-screened and -extracted data on study characteristics, key predefined components of the target trial protocol and its emulation (eligibility criteria, treatment strategies, treatment assignment, outcome[s], follow-up, causal contrast[s], and analysis plan), and other items related to the target trial emulation.FindingsA total of 200 studies that explicitly aimed to emulate a target trial were included. These studies included 26 subfields of medicine, and 168 (84%) were published from January 2020 to October 2022. The aim to emulate a target trial was explicit in 70 study titles (35%). Forty-three studies (22%) reported use of a published reporting guideline (eg, Strengthening the Reporting of Observational Studies in Epidemiology). Eighty-five studies (43%) did not describe all key items of how the target trial was emulated and 113 (57%) did not describe the protocol of the target trial and its emulation.Conclusion and RelevanceIn this systematic review of 200 studies that explicitly aimed to emulate a target trial, reporting of how the target trial was emulated was inconsistent. A reporting guideline for studies explicitly aiming to emulate a target trial may improve the reporting of the target trial protocols and other aspects of these emulation attempts.

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Yoga vs Cognitive Processing Therapy for Military Sexual Trauma–Related Posttraumatic Stress Disorder

Zaccari,

Higgins,

Haywood

et al. 2023

JAMA Netw Open

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ImportanceFirst-line treatment for posttraumatic stress disorder (PTSD) in the US Department of Veterans Affairs (VA), ie, trauma-focused therapy, while effective, is limited by low treatment initiation, high dropout, and high treatment refraction.ObjectiveTo evaluate the effectiveness of Trauma Center Trauma-Sensitive Yoga (TCTSY) vs first-line cognitive processing therapy (CPT) in women veterans with PTSD related to military sexual trauma (MST) and the hypothesis that PTSD outcomes would differ between the interventions.Design, Setting, and ParticipantsThis multisite randomized clinical trial was conducted from December 1, 2015, to April 30, 2022, within 2 VA health care systems located in the southeast and northwest. Women veterans aged 22 to 71 years with MST-related PTSD were enrolled and randomized to TCTSY or CPT.InterventionsThe TCTSY intervention (Hatha-style yoga focusing on interoception and empowerment) consisted of 10 weekly, 60-minute group sessions, and the CPT intervention (cognitive-based therapy targeting modification of negative posttraumatic thoughts) consisted of 12 weekly, 90-minute group sessions.Main Outcome and MeasuresSociodemographic data were collected via self-report survey. The primary outcome, PTSD symptom severity, was assessed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and PTSD Checklist for DSM-5 (PCL-5). Assessments were conducted at baseline, midintervention, 2 weeks post intervention, and 3 months post intervention.ResultsOf 200 women veterans who consented to participate, the intent-to-treat sample comprised 131 participants (mean [SD] age, 48.2 [11.2] years), with 72 randomized to TCTSY and 59 randomized to CPT. Treatment was completed by 47 participants (65.3%) in the TCTSY group and 27 (45.8%) in the CPT group, a 42.6% higher treatment completion rate in the TCTSY group (P = .03). Both treatment groups improved over time on the CAPS-5 (mean [SD] scores at baseline: 36.73 [8.79] for TCTSY and 35.52 [7.49] for CPT; mean [SD] scores at 3 months: 24.03 [11.55] for TCTSY and 22.15 [13.56]) and the PCL-5 (mean [SD] scores at baseline: 49.62 [12.19] for TCTSY and 48.69 [13.62] for CPT; mean [SD] scores at 3 months: 36.97 [17.74] for TCTSY and 31.76 [12.47]) (P &lt; .001 for time effects). None of the group effects or group-by-time effects were significant. Equivalence analyses of change scores were not significantly different between the TCTSY and CPT groups, and the two one-sided test intervals fell within the equivalence bounds of plus or minus 10 for CAPS-5 for all follow-up time points.Conclusions and RelevanceIn this comparative effectiveness randomized clinical trial, TCTSY was equivalent to CPT in reducing PTSD symptom severity, with both groups improving significantly. The higher treatment completion rate for TCTSY indicates its higher acceptability as an effective and acceptable PTSD treatment for women veterans with PTSD related to MST that could address current VA PTSD treatment limitations.Trial RegistrationClinicalTrials.gov Identifier: NCT02640690

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Effectiveness and comparative effectiveness of evidence-based psychotherapies for posttraumatic stress disorder in clinical practice

Cited by 21 publications

References 42 publications

Improvements to PTSD quality metrics with natural language processing

Improvements to PTSD quality metrics with natural language processing

Reporting of Observational Studies Explicitly Aiming to Emulate Randomized Trials

Yoga vs Cognitive Processing Therapy for Military Sexual Trauma–Related Posttraumatic Stress Disorder

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