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Implement Sci. 2016 Apr 30;11:58. doi: 10.1186/s13012-016-0424-4.

An effectiveness-implementation hybrid trial study protocol targeting posttraumatic stress disorder and comorbidity.

Author information

1
Department of Psychiatry & Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA. dzatzick@uw.edu.
2
Harborview Injury Prevention Research Center, University of Washington, 325 Ninth Ave, Box 359960, Seattle, WA, 98104, USA. dzatzick@uw.edu.
3
Department of Psychiatry & Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA.
4
Division of Cancer Control and Population Sciences, National Cancer Institute, BG 9609 MSC 9760, 9609 Medical Center Drive, Bethesda, MD, 20892-9760, USA.
5
School of Social Work, University of Southern California, Montgomery Ross Fisher Building, Room 339, Los Angeles, CA, 90089, USA.
6
Department of Surgery, University of Washington, 325 Ninth Ave, Box 359796, Seattle, WA, 98104, USA.
7
Harborview Injury Prevention Research Center, University of Washington, 325 Ninth Ave, Box 359960, Seattle, WA, 98104, USA.
8
Department of Biostatistics, University of Washington, 1705 NE Pacific St, Box 357232, Seattle, WA, 98195, USA.
9
Division of Emergency Medicine, University of Washington, 25 Ninth Ave, Box 359702, Seattle, WA, 98104, USA.
10
Department of Surgery, University of California in Davis, 2221 Stockton Blvd, Cypress #3111, Sacramento, CA, 95817, USA.

Abstract

BACKGROUND:

Each year in the USA, 1.5-2.5 million Americans are so severely injured that they require inpatient hospitalization. Multiple conditions including posttraumatic stress disorder (PTSD), alcohol and drug use problems, depression, and chronic medical conditions are endemic among physical trauma survivors with and without traumatic brain injuries.

METHODS/DESIGN:

The trauma survivors outcomes and support (TSOS) effectiveness-implementation hybrid trial is designed to test the delivery of high-quality screening and intervention for PTSD and comorbidities across 24 US level I trauma center sites. The pragmatic trial aims to recruit 960 patients. The TSOS investigation employs a stepped wedge cluster randomized design in which sites are randomized sequentially to initiate the intervention. Patients identified by a 10-domain electronic health record screen as high risk for PTSD are formally assessed with the PTSD Checklist for study entry. Patients randomized to the intervention condition will receive stepped collaborative care, while patients randomized to the control condition will receive enhanced usual care. The intervention training begins with a 1-day on-site workshop in the collaborative care intervention core elements that include care management, medication, cognitive behavioral therapy, and motivational-interviewing elements targeting PTSD and comorbidity. The training is followed by site supervision from the study team. The investigation aims to determine if intervention patients demonstrate significant reductions in PTSD and depressive symptoms, suicidal ideation, alcohol consumption, and improvements in physical function when compared to control patients. The study uses implementation science conceptual frameworks to evaluate the uptake of the intervention model. At the completion of the pragmatic trial, results will be presented at an American College of Surgeons' policy summit. Twenty-four representative US level I trauma centers have been selected for the study, and the protocol is being rolled out nationally.

DISCUSSION:

The TSOS pragmatic trial simultaneously aims to establish the effectiveness of the collaborative care intervention targeting PTSD and comorbidity while also addressing sustainable implementation through American College of Surgeons' regulatory policy. The TSOS effectiveness-implementation hybrid design highlights the importance of partnerships with professional societies that can provide regulatory mandates targeting enhanced health care system sustainability of pragmatic trial results.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02655354 . Registered 27 July 2015.

KEYWORDS:

American College of Surgeons; Depression; Effectiveness-implementation hybrid; Multiple chronic conditions; Policy; Posttraumatic stress disorder; Pragmatic clinical trial; Substance abuse; Suicidal ideation; Traumatic injury

PMID:
27130272
PMCID:
PMC4851808
DOI:
10.1186/s13012-016-0424-4
[Indexed for MEDLINE]
Free PMC Article

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