title: Technology-Enhanced Stepped Collaborative Care Targeting Posttraumatic Stress Disorder and Comorbidity After Injury: A Randomized Controlled Trial.
abstract: Posttraumatic stress disorder (PTSD) and its comorbidities are endemic among injured trauma survivors. Previous collaborative care trials targeting PTSD after injury have been effective, but they have required intensive clinical resources. The present pragmatic clinical trial randomized acutely injured trauma survivors who screened positive on an automated electronic medical record PTSD assessment to collaborative care intervention (n = 60) and usual care control (n = 61) conditions. The stepped measurement-based intervention included care management, psychopharmacology, and psychotherapy elements. Embedded within the intervention were a series of information technology (IT) components. PTSD symptoms were assessed with the PTSD Checklist at baseline prerandomization and again, 1-, 3-, and 6-months postinjury. IT utilization was also assessed. The technology-assisted intervention required a median of 2.25 hours (interquartile range = 1.57 hours) per patient. The intervention was associated with modest symptom reductions, but beyond the margin of statistical significance in the unadjusted model: F(2, 204) = 2.95, p = .055. The covariate adjusted regression was significant: F(2, 204) = 3.06, p = .049. The PTSD intervention effect was greatest at the 3-month (Cohen's effect size d = 0.35, F(1, 204) = 4.11, p = .044) and 6-month (d = 0.38, F(1, 204) = 4.10, p = .044) time points. IT-enhanced collaborative care was associated with modest PTSD symptom reductions and reduced delivery times; the intervention model could potentially facilitate efficient PTSD treatment after injury.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.|Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Zatzick
authors.affiliation: Department of Psychological Sciences, Western Kentucky University, Bowling Green, Kentucky, USA.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: O'Connor
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Joan
authors.initials: J
authors.lastname: Russo
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.|Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Nigel
authors.initials: N
authors.lastname: Bush
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Love
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Roselyn
authors.initials: R
authors.lastname: Peterson
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Ingraham
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Doyanne
authors.initials: D
authors.lastname: Darnell
authors.affiliation: Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Whiteside
authors.affiliation: Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Erik
authors.initials: E
authors.lastname: Van Eaton
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D003299:Cooperative Behavior; D020000:Decision Support Systems, Clinical / Q000458:organization & administration* / Q000592:standards; D019033:Delivery of Health Care, Integrated / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D062405:Motivational Interviewing / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D018570:Risk Assessment; D012309:Risk-Taking; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D014481:United States; D014947:Wounds and Injuries / Q000150:complications / Q000523:psychology*
chemical_list: D000928:Antidepressive Agents