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This project evaluated the impact of semi-structured, standardized interviews on the initial PTSD C&P on the examination.
Our objective is to compare the process and outcomes of C&P exams for PTSD conducted with CAPS and WHODAS-II interviews versus the PTSD exams conducted without the CAPS and WHODAS-II interviews. This project will conduct a randomized controlled trial on 688 veterans to evaluate the effects of the CAPS/WHODAS instruments on the initial PTSD C&P examination process. Study outcomes include variation in assessing the DSM-IV components of PTSD, diagnostic accuracy, veteran perception of the exam process, VBA rater utility and resource utilization. This project will 1) demonstrate the feasibility of conducting program evaluation and intervention studies on the PTSD C&P examination process, 2) develop research tools, instruments and methods for C&P evaluation, 3) provide data on the value-added contribution of CAPS and WHODAS-II to the PTSD assessment process and examination report, and 4) inform the business case of utilizing the CAPS and WHODAS-II in the PTSD C&P process. The ultimate aim is to improve the reproducibility, consistency and validity of the PTSD examination process while maintaining a level of efficiency and cost restraint that provides veterans with an exam process that is fair, accurate and equitable across VHA.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| CAPS/WHODAS | Experimental | PTSD assessed using Clinical Assessment of PTSD Symptoms (CAPS) and WHODAS functional impairment structured evidence-based interview |
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| Nonstructured Interview | Active Comparator | Usual clinical interview to assess PTSD, without CAPS or WHODAS |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| CAPS/WHODAS | Behavioral | CAPS/WHODAS structured clinical PTSD interview |
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| Measure | Description | Time Frame |
|---|---|---|
| Completeness and Quality of PTSD Interview | total completeness of diagnostic assessment score, range from 0 to 100% and completeness of functional assessment | Post-exam, same day |
| Measure | Description | Time Frame |
|---|---|---|
| PTSD Diagnosis | Number of participants who were unable to receive a conclusive clinician PTSD diagnosis for positive or negative PTSD symptoms (unable to determine clinician diagnosis). | Post-exam, same day |
| Patient Satisfaction |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Theodore Speroff, PhD | Tennessee Valley Healthcare System Nashville Campus, Nashville, TN | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR | North Little Rock | Arkansas | 72114-1706 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 23821175 | Result | Rosen MI, Afshartous D, Marx BP. Did microinsults and microaggressions play a role?: in reply. Psychiatr Serv. 2013 Jul 1;64(7):713. doi: 10.1176/appi.ps.640703. No abstract available. | |
| 23318842 | Result | Rosen MI, Afshartous DR, Nwosu S, Scott MC, Jackson JC, Marx BP, Murdoch M, Sinnott PL, Speroff T. Racial differences in veterans' satisfaction with examination of disability from posttraumatic stress disorder. Psychiatr Serv. 2013 Apr 1;64(4):354-9. doi: 10.1176/appi.ps.201100526. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Arm 1 | PTSD interview using CAPS and WHODAS Clinician Assessment of PTSD Symptoms (CAPS): CAPS/WHODAS structured clinical PTSD interview |
| FG001 | Arm 2 | Usual PTSD interview, without CAPS or WHODAS Nonstructured Interview: Usual PTSD clinical PTSD interview, not CAPS or SCID |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| Nonstructured Interview |
| Behavioral |
Usual PTSD clinical PTSD interview, not CAPS or SCID |
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Mean score on satisfaction survey rating scale from 1 to 5 (higher)
| post-exam, same day |
| Resource Utilization | time spent administering the exam | same day |
| VA Palo Alto Health Care System, Palo Alto, CA | Palo Alto | California | 94304-1290 | United States |
| VA Connecticut Healthcare System West Haven Campus, West Haven, CT | West Haven | Connecticut | 06516 | United States |
| Southeast Louisiana Veterans Health Care System, New Orleans, LA | New Orleans | Louisiana | 70112 | United States |
| VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA | Boston | Massachusetts | 02130 | United States |
| John D. Dingell VA Medical Center, Detroit, MI | Detroit | Michigan | 48201 | United States |
| Minneapolis VA Health Care System, Minneapolis, MN | Minneapolis | Minnesota | 55417 | United States |
| New Mexico VA Health Care System, Albuquerque, NM | Albuquerque | New Mexico | 87108-5153 | United States |
| Memphis VA Medical Center, Memphis, TN | Memphis | Tennessee | 38104 | United States |
| Tennessee Valley Healthcare System Nashville Campus, Nashville, TN | Nashville | Tennessee | 37212-2637 | United States |
| Clement J. Zablocki VA Medical Center, Milwaukee, WI | Milwaukee | Wisconsin | 53295-1000 | United States |
| 23225029 | Result | Speroff T, Sinnott PL, Marx B, Owen RR, Jackson JC, Greevy R, Sayer N, Murdoch M, Shane AC, Smith J, Alvarez J, Nwosu SK, Keane T, Weathers F, Schnurr PP, Friedman MJ. Impact of evidence-based standardized assessment on the disability clinical interview for diagnosis of service-connected PTSD: a cluster-randomized trial. J Trauma Stress. 2012 Dec;25(6):607-15. doi: 10.1002/jts.21759. |
| Result | Marx BP, Jackson JC, Schnuff PP, Murdoch M, Sayer NA, Keane TM, Friedman MJ, Greevy RA, Owen RR, Sinnott PL, Speroff T. The reality of malingered PTSD among Veterans: Reply to McNally and Frueh. Journal of traumatic stress. 2012 Aug 1; 25(4):457-60. |
| 21913226 | Result | Jackson JC, Sinnott PL, Marx BP, Murdoch M, Sayer NA, Alvarez JM, Greevy RA, Schnurr PP, Friedman MJ, Shane AC, Owen RR, Keane TM, Speroff T. Variation in practices and attitudes of clinicians assessing PTSD-related disability among veterans. J Trauma Stress. 2011 Oct;24(5):609-13. doi: 10.1002/jts.20688. Epub 2011 Sep 12. |
| 18410194 | Result | Marx BP, Marshall PJ, Castro F. The moderating effects of stimulus valence and arousal on memory suppression. Emotion. 2008 Apr;8(2):199-207. doi: 10.1037/1528-3542.8.2.199. |
| 18410204 | Result | Sloan DM, Marx BP, Epstein EM, Dobbs JL. Expressive writing buffers against maladaptive rumination. Emotion. 2008 Apr;8(2):302-6. doi: 10.1037/1528-3542.8.2.302. |
| COMPLETED |
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| NOT COMPLETED |
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Veterans undergoing compensation and pension examination for PTSD
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| ID | Title | Description |
|---|---|---|
| BG000 | Arm 1 | PTSD interview using CAPS and WHODAS Clinician Assessment of PTSD Symptoms (CAPS): CAPS/WHODAS structured clinical PTSD interview |
| BG001 | Arm 2 | Usual PTSD interview, without CAPS or WHODAS Nonstructured Interview: Usual PTSD clinical PTSD interview, not CAPS or SCID |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Median | Inter-Quartile Range | years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
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| Marital Status | Number | participants |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Primary | Completeness and Quality of PTSD Interview | total completeness of diagnostic assessment score, range from 0 to 100% and completeness of functional assessment | Posted | Mean | Standard Deviation | percentage of criteria PTSD assessment | Post-exam, same day |
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| Secondary | PTSD Diagnosis | Number of participants who were unable to receive a conclusive clinician PTSD diagnosis for positive or negative PTSD symptoms (unable to determine clinician diagnosis). | Posted | Number | participants | Post-exam, same day |
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| Secondary | Patient Satisfaction | Mean score on satisfaction survey rating scale from 1 to 5 (higher) | Posted | Mean | Standard Deviation | units on a scale | post-exam, same day |
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| Secondary | Resource Utilization | time spent administering the exam | Posted | Mean | Standard Deviation | minutes | same day |
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Day of disability examination
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Arm 1 | PTSD interview using CAPS and WHODAS Clinician Assessment of PTSD Symptoms (CAPS): CAPS/WHODAS structured clinical PTSD interview | 0 | 176 | 0 | 176 | ||
| EG001 | Arm 2 | Usual PTSD interview, without CAPS or WHODAS Nonstructured Interview: Usual PTSD clinical PTSD interview, not CAPS or SCID | 0 | 208 | 0 | 208 |
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Information external to interview such as psychological testing or charts were not available to the expert reviewers. Another limitation is that Veterans in our study did not undergo a concurrent, independent evaluation for assessment of PTSD.
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Theodore Speroff PhD | Veterans Affairs at TVHS | 615-636-9476 | ted.speroff@va.gov |
| ID | Term |
|---|---|
| D013313 | Stress Disorders, Post-Traumatic |
| ID | Term |
|---|---|
| D040921 | Stress Disorders, Traumatic |
| D000068099 | Trauma and Stressor Related Disorders |
| D001523 | Mental Disorders |
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| Male |
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| Asian |
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| Native Hawaiian or Other Pacific Islander |
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| Black or African American |
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| White |
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| More than one race |
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| Unknown or Not Reported |
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| Single |
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| Separated |
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| Other/Missing |
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| Superiority or Other |
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