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Health Serv Res. 2000 April; 35(1 Pt 1): 133–151.
PMCID: PMC1089118

Outcomes monitoring and the testing of new psychiatric treatments: work therapy in the treatment of chronic post-traumatic stress disorder.


OBJECTIVE: To evaluate the effectiveness of a work therapy intervention, the Department of Veterans Affairs (VA) Compensated Work Therapy program (CWT), in the treatment of patients suffering from chronic war-related post-traumatic stress disorder (PTSD); and to demonstrate methods for using outcomes monitoring data to screen previously untested treatments. DATA SOURCES/STUDY SETTING: Baseline and four-month follow-up questionnaires administered to 3,076 veterans treated in 52 specialized VA inpatient programs for treatment of PTSD at facilities that also had CWT programs. Altogether 78 (2.5 percent) of these patients participated in CWT during the four months after discharge. STUDY DESIGN: The study used a pre-post nonequivalent control group design. DATA COLLECTION/EXTRACTION METHODS: Questionnaires documented PTSD symptoms, violent behavior, alcohol and drug use, employment status, and medical status at the time of program entry and four months after discharge from the hospital to the community. Administrative databases were used to identify participants in the CWT program. Propensity scores were used to match CWT participants and other patients, and hierarchical linear modeling was used to evaluate differences in outcomes between treatment groups on seven outcomes. PRINCIPAL FINDINGS: The propensity scaling method created groups that were not significantly different on any measure. No greater improvement was observed among CWT participants than among other patients on any of seven outcome measures. CONCLUSIONS: Substantively this study suggests that work therapy, as currently practiced in VA, is not an effective intervention, at least in the short term, for chronic, war-related PTSD. Methodologically it illustrates the use of outcomes monitoring data to screen previously untested treatments and the use of propensity scoring and hierarchical linear modeling to adjust for selection biases in observational studies.

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Selected References

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  • Blumenthal D. Part 1: Quality of care--what is it? N Engl J Med. 1996 Sep 19;335(12):891–894. [PubMed]
  • Clardy JA, Booth BM, Smith LG, Nordquist CR, Smith GR. Implementing a statewide outcomes management system for consumers of public mental health services. Psychiatr Serv. 1998 Feb;49(2):191–195. [PubMed]
  • Davidson JR. Biological therapies for posttraumatic stress disorder: an overview. J Clin Psychiatry. 1997;58 (Suppl 9):29–32. [PubMed]
  • Drake C, Fisher L. Prognostic models and the propensity score. Int J Epidemiol. 1995 Feb;24(1):183–187. [PubMed]
  • Ellwood PM. Shattuck lecture--outcomes management. A technology of patient experience. N Engl J Med. 1988 Jun 9;318(23):1549–1556. [PubMed]
  • Fontana A, Rosenheck R. Effects of compensation-seeking on treatment outcomes among veterans with posttraumatic stress disorder. J Nerv Ment Dis. 1998 Apr;186(4):223–230. [PubMed]
  • Johnson DR, Lubin H, James M, Hale K. Single session effects of treatment components within a specialized inpatient posttraumatic stress disorder program. J Trauma Stress. 1997 Jul;10(3):377–390. [PubMed]
  • Johnson DR, Rosenheck R, Fontana A, Lubin H, Charney D, Southwick S. Outcome of intensive inpatient treatment for combat-related posttraumatic stress disorder. Am J Psychiatry. 1996 Jun;153(6):771–777. [PubMed]
  • Lehman AF. Vocational rehabilitation in schizophrenia. Schizophr Bull. 1995;21(4):645–656. [PubMed]
  • McLellan AT, Luborsky L, Cacciola J, Griffith J, Evans F, Barr HL, O'Brien CP. New data from the Addiction Severity Index. Reliability and validity in three centers. J Nerv Ment Dis. 1985 Jul;173(7):412–423. [PubMed]
  • Mueser KT, Drake RE, Bond GR. Recent advances in psychiatric rehabilitation for patients with severe mental illness. Harv Rev Psychiatry. 1997 Sep-Oct;5(3):123–137. [PubMed]
  • Rosenheck R, Wilson NJ, Meterko M. Influence of patient and hospital factors on consumer satisfaction with inpatient mental health treatment. Psychiatr Serv. 1997 Dec;48(12):1553–1561. [PubMed]
  • Rubin DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med. 1997 Oct 15;127(8 Pt 2):757–763. [PubMed]
  • Solomon SD, Gerrity ET, Muff AM. Efficacy of treatments for posttraumatic stress disorder. An empirical review. JAMA. 1992 Aug 5;268(5):633–638. [PubMed]
  • Steinwachs DM, Wu AW, Skinner EA. How will outcomes management work? Health Aff (Millwood) 1994 Fall;13(4):153–162. [PubMed]

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