David C Mohr1, Craig S Rosen1, Paula P Schnurr1, Robert J Orazem1, Siamak Noorbaloochi1, Barbara A Clothier1, Afsoon Eftekhari1, Nancy C Bernardy1, Kathleen M Chard1, Jill J Crowley1, Joan M Cook1, Shannon M Kehle-Forbes1, Josef I Ruzek1, Nina A Sayer1. 1. Dr. Mohr is with the Center for Healthcare Organization and Implementation Research and Dr. Kehle-Forbes is with the National Center for PTSD Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) Boston Healthcare System, Boston. Dr. Mohr is also with the School of Public Health, Boston University, Boston. Dr. Kehle-Forbes is also with the Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, where Mr. Orazem, Dr. Noorbaloochi, Ms. Clothier, and Dr. Sayer are affiliated. Dr. Noorbaloochi and Dr. Sayer are also with the Department of Medicine, University of Minnesota, Minneapolis. Dr. Rosen, Dr. Eftekhari, Dr. Crowley, and Dr. Ruzek are with the Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California. Dr. Rosen and Dr. Ruzek are also with the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California. Dr. Schnurr and Dr. Bernardy are with the Executive Division, National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont, and also with the Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Chard is with the PTSD Division, Cincinnati VA Medical Center, Cincinnati. Dr. Cook is with the Evaluation Division, National Center for PTSD, and with the Yale University School of Medicine, both in New Haven, Connecticut.
Abstract
OBJECTIVE: It has been over a decade since the U.S. Department of Veterans Affairs (VA) began formal dissemination and implementation of two trauma-focused evidence-based psychotherapies (TF-EBPs). The objective of this study was to examine the sustainability of the TF-EBPs and determine whether team functioning and workload were associated with TF-EBP sustainability. METHODS: This observational study used VA administrative data for 6,251 patients with posttraumatic stress disorder (PTSD) and surveys from 78 providers from 10 purposefully selected PTSD clinical teams located in nine VA medical centers. The outcome was sustainability of TF-EBPs, which was based on British National Health System Sustainability Index scores (possible scores range from 0 to 100.90). Primary predictors included team functioning, workload, and TB-EBP reach to patients with PTSD. Multiple linear regression models were used to examine the influence of team functioning and workload on TF-EBP sustainability after adjustment for covariates that were significantly associated with sustainability. RESULTS: Sustainability Index scores ranged from 53.15 to 100.90 across the 10 teams. Regression models showed that after adjustment for patient and facility characteristics, team functioning was positively associated (B=9.16, p<.001) and workload was negatively associated (B=-.28, p<.05) with TF-EBP sustainability. CONCLUSIONS: There was considerable variation across teams in TF-EBP sustainability. The contribution of team functioning and workload to the sustainability of evidence-based mental health care warrants further study.
OBJECTIVE: It has been over a decade since the U.S. Department of Veterans Affairs (VA) began formal dissemination and implementation of two trauma-focused evidence-based psychotherapies (TF-EBPs). The objective of this study was to examine the sustainability of the TF-EBPs and determine whether team functioning and workload were associated with TF-EBP sustainability. METHODS: This observational study used VA administrative data for 6,251 patients with posttraumatic stress disorder (PTSD) and surveys from 78 providers from 10 purposefully selected PTSD clinical teams located in nine VA medical centers. The outcome was sustainability of TF-EBPs, which was based on British National Health System Sustainability Index scores (possible scores range from 0 to 100.90). Primary predictors included team functioning, workload, and TB-EBP reach to patients with PTSD. Multiple linear regression models were used to examine the influence of team functioning and workload on TF-EBP sustainability after adjustment for covariates that were significantly associated with sustainability. RESULTS: Sustainability Index scores ranged from 53.15 to 100.90 across the 10 teams. Regression models showed that after adjustment for patient and facility characteristics, team functioning was positively associated (B=9.16, p<.001) and workload was negatively associated (B=-.28, p<.05) with TF-EBP sustainability. CONCLUSIONS: There was considerable variation across teams in TF-EBP sustainability. The contribution of team functioning and workload to the sustainability of evidence-based mental health care warrants further study.
Authors: Nina A Sayer; Nancy C Bernardy; Matthew Yoder; Jessica L Hamblen; Craig S Rosen; Princess E Ackland; Shannon M Kehle-Forbes; Barbara A Clothier; Paula P Schnurr; Robert J Orazem; Siamak Noorbaloochi Journal: Adm Policy Ment Health Date: 2020-09-17
Authors: Joan M Cook; Vanessa Simiola; Richard Thompson; Margaret-Anne Mackintosh; Craig Rosen; Nina Sayer; Paula P Schnurr Journal: J Trauma Stress Date: 2020-06-25