title: Impact of evidence-based standardized assessment on the disability clinical interview for diagnosis of service-connected PTSD: a cluster-randomized trial.
abstract: Posttraumatic stress disorder (PTSD) is one of the fastest growing compensated medical conditions. The present study compared usual disability examiner practices for PTSD with a standardized assessment that incorporates evidence-based assessments. The design was a multicenter, cluster randomized, parallel-group study involving 33 clinical examiners and 384 veterans at 6 Veterans Affairs medical centers. The standardized group incorporated the Clinician Administered PTSD Scale and the World Health Organization Disability Assessment Schedule-II into their assessment interview. The main outcome measures were completeness and accuracy of PTSD diagnosis and completeness of functional assessment. The standardized assessments were 85% complete for diagnosis compared to 30% for nonstandardized assessments (p < .001), and, for functional impairment, 76% versus 3% (p < .001). The findings demonstrate that the quality of PTSD disability examination would be improved by using evidence-based assessment.
authors.affiliation: Center for Health Services Research, Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA. ted.speroff@vanderbilt.edu
authors.forename: Theodore
authors.initials: T
authors.lastname: Speroff
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Sinnott
authors.forename: Brian
authors.initials: B
authors.lastname: Marx
authors.forename: Richard R
authors.initials: RR
authors.lastname: Owen
authors.forename: James C
authors.initials: JC
authors.lastname: Jackson
authors.forename: Robert
authors.initials: R
authors.lastname: Greevy
authors.forename: Nina
authors.initials: N
authors.lastname: Sayer
authors.forename: Maureen
authors.initials: M
authors.lastname: Murdoch
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Shane
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Smith
authors.forename: JoAnn
authors.initials: J
authors.lastname: Alvarez
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Nwosu
authors.forename: Terence
authors.initials: T
authors.lastname: Keane
authors.forename: Frank
authors.initials: F
authors.lastname: Weathers
authors.forename: Paula P
authors.initials: PP
authors.lastname: Schnurr
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Friedman
mesh_terms: D000293:Adolescent; D000328:Adult; D004185:Disability Evaluation; D006233:Persons with Disabilities; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis*; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis*; D014481:United States; D014728:Veterans; D055815:Young Adult