Health Services Research & Development

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ESP Reports in Progress

ESP Reports  ESP Topic Nomination  ESP Reports in Progress

The following reports are under development at one of the four ESP sites. If you would like to provide comments about the topic under development, serve as a peer reviewer for the draft report, or know the timeline for completion, please contact the ESP Coordinating Center.

To review the most up-to-date protocols, please visit the PROSPERO website. Protocol registration numbers for an individual project can be found along with the brief abstract for the project, below.




Relationship of TBI to PTSD, Depression, Substance Abuse, Anxiety, and Suicidal Ideation: A Systematic Review

PROSPERO registration number: CRD42018083990

Background/Objectives of Review

This report will be used by the Veterans Health Administration TBI Advisory Committee to inform clinical practice guideline development. The report will also be used to inform Office of Research and Development future research priorities.

Key Questions

KQ1a: Is the prevalence of mental health conditions (post-traumatic stress disorder [PTSD], depression, substance abuse, suicidal ideation, and general anxiety disorders) differ in service members and Veterans with and without combat-deployed mild TBI?

KQ1b: How do severity and symptom persistence of mental health conditions (PTSD, depression, substance abuse, suicidal ideation, and general anxiety disorders) different in service members and Veterans with and without combat-deployed mild traumatic brain injury (TBI) (one or more)?

KQ2: What are the effectiveness and comparative effectiveness and harms of established pharmacological or nonpharmacological interventions for treatment of PTSD, depression, substance abuse, suicidal ideation, and general anxiety disorders in service members and Veterans with history of combat-deployed mild TBI-related symptoms?

PICOTS

Population(s): Service members and Veterans with one or more combat-deployed mild TBI(s).

Interventions: Combat-deployed mild TBI(s) (KQ 1-2); pharmacological interventions for the management of mental health conditions (KQ 2); nonpharmacological interventions for the management of mental health conditions (KQ 2).

Comparator: Veterans and service members without combat-deployed mild TBI(s) (KQ 1); placebo or alternative pharmacological or nonpharmacological intervention including wait-list controls (KQ 2).

Outcome(s): Prevalence, severity, and symptom persistence of PTSD, depression, substance abuse, suicidal ideation, or general anxiety disorder (short term ≤ 1 year, long term > 1 year) in service members and Veterans with and without combat-deployed mild TBI(s); effectiveness of interventions (ie, changes in symptoms, function, and quality of life measures and harms) for the treatment of mental health conditions of interest in service members and Veterans with and without combat-deployed mild TBI(s).

General Search Strategy

MEDLINE search using the search strategy below. We will also search PsycINFO, the PILOTS database, publications from VA HSR&D, and research for the Defence and Veterans Brain Injury Center.

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Pharmacotherapy for Stimulant Use Disorders: A Systematic Review

PROSPERO registration number: CRD42018085667

Background/Objectives of Review

The review will be used by the Office of Mental Health Services to inform national VHA policy on VA substance use disorder (SUD) treatment. CESATE will also disseminate the findings to the field to help ensure medication-assisted SUD treatments available to Veterans include the latest evidence on effectiveness and harms. This review also has the potential to inform future SUD research priorities by identifying gaps in the literature.

Key Questions

KQ1: What are the benefits and harms of pharmacotherapy for cocaine use disorder (alone, or as an adjunct or follow-up to psychosocial treatment)?

KQ2: Are there known subpopulations for which different forms of pharmacotherapy is most/least effective for cocaine use disorder?

KQ3: What are the benefits and harms of pharmacotherapy for amphetamine/methamphetamine use disorder (alone, or as an adjunct or follow-up to psychosocial treatment)?

KQ4:  Are there known subpopulations for which different forms of pharmacotherapy is most/least effective for amphetamine/methamphetamine use disorder?

PICOTS

Population(s): Included: Non-pregnant adults with cocaine or amphetamine/methamphetamine use disorder.

Excluded: subjects with psychotic spectrum disorder, bipolar disorder.

Interventions: Included: Pharmacotherapies identified as a potential treatment for cocaine or amphetamine/methamphetamine use disorder (common adjuncts may be med management; interpersonal therapy; contingency management (or motivational incentives); CBT (including matrix therapy, relapse prevention)

Excluded:  treatment for temporary psychosis associated with stimulant overdose.

Comparator: Usual care, placebo, or other interventions (control groups should receive the same adjunctive treatments)

Outcome(s): Intermediate/Behavioral outcomes: Abstinence (UTS only; self-report only in addition to UTS); Also of interest when available: Longest Duration of Abstinence (LDA), and whether patients reach at least Three Consecutive Weeks (21 or more days) of abstinence. Reduction of cocaine use (eg, last 30 days, last 3 months, ASI included number of days of use, quantitative urine levels). Retention in treatment.

Health and other outcomes: Morbidity/mortality; Quality of Life; Legal/employment outcomes

Harms: Withdrawal due to AE, and severe AE (as reported in the trials)

General Search Strategy

Search strategies will be developed in consultation with a research librarian, and will be peer reviewed by a second research librarian using the instrument for Peer Review of Search Strategies (PRESS). We plan to conduct a primary review of the literature by systematically searching, reviewing, and analyzing the scientific evidence as it pertains to the research questions. To identify relevant articles, we will begin by searching Ovid MEDLINE, OvidPsycINFO, and Ovid EBM Reviews Cochrane Database of Systematic Reviews (CDSR, DARE, HTA, Cochrane CENTRAL, etc). We will search all available years of publication from database inception (1946 for Ovid MEDLINE) through November 2017. We will review the bibliographies of relevant articles and contact experts to identify additional studies. To identify in-progress or unpublished studies, we will search ClinicalTrials.gov, OpenTrials, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP).

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Best Emergency Department Practices for Older Adults

PROSPERO registration number: CRD42018087660

Key Questions

How effective are Emergency Department health system interventions in improving clinical, patient experience, and utilization outcomes in older adults (age ≥ 65)?

Health system interventions may include one or more of the following strategies:

  • Transitional care/discharge planning
  • Comprehensive geriatric assessment with linkage to services or changes to the care plan based on this assessment
  • Case management
  • Medication safety programs/polypharmacy
  • Geriatric emergency departments designed to conform to the 2014 ACEP guidelines.

PICOTS

Population(s): Adults age 65 and older who present to an emergency department for acute/urgent/emergency care or are identified from ED logs to target for a follow-up intervention that occurs outside the ED.

Interventions: Transitional care/discharge planning; Comprehensive geriatric assessment with linkage to services or changes to the care plan based on this assessment; Case management; Medication safety programs/polypharmacy; Geriatric emergency departments designed to conform to the 2014 ACEP guidelines.

Comparator: Usual emergency department care or enhanced usual emergency department care.

Outcome(s): Clinical outcomes (functional status, quality of life, mortality); Patient satisfaction/experience; Care utilization (ED readmission up to 90 days following index visit, hospitalization following ED discharge); We will track whether studies report costs, but because the data are likely skewed and/or infrequently reported, and thus may not be relevant to VA, we will not synthesize cost data.

General Search Strategy

We will conduct a primary search of MEDLINE® (via PubMed®), Embase, and CINAHL. We anticipate using a combination of MeSH keywords and selected free-text terms to search titles and abstracts. To ensure completeness, search strategies will be developed in consultation with an expert librarian. Because we identified recent high-quality systematic reviews and an evidence map on relevant topics, our search will be designed to start 6 months prior to the search strategy from these reviews. In addition, we will search the gray literature via ClinicalTrials.gov and SCOPUS.

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Strategies for Full System Scale/Spread

Key Questions

What strategies have been used to scale up and spread clinical and administrative practices across healthcare systems, with special attention paid to sites with poor performance or that may be hard to engage in improvement initiatives?

  1. What macro-organizational strategies (ie, at the whole organization or system level) have been used in spread and scale efforts?
    a. What macro-organizational strategies (ie, at the whole organization or system level) were used with sites with poor performance or that may be hard to engage in improvement initiatives?
  2. What micro-organizational strategies (ie, at the individual or group/team level) have been used in spread and scale efforts?
    b. What micro-organizational strategies (ie, at the individual or group/team level) have been used in spread and scale efforts with sites with poor performance or that may be hard to engage in improvement initiatives?
  3. PICOTS

    Population(s): Multi-site health care systems

    Interventions: n/a

    Comparator: n/a

    Outcome(s): Uptake of practices across multiple sites within a health care system; ability to produce intended outcomes (eg, cost containment, access to care, coordination among care providers, patient outcomes, etc)

    Context: Large health care systems in high-income countries improving clinical care or administrative performance.

    General Search Strategy

    We will procure literature from 3 main sources:

    1. A systematic search of PubMed and WorldCat databases using terms related to “learning health systems”.
    2. A systematic search of PubMed, WorldCat, Web of Science, and Business Source Complete databases using terms related to “scale and spread”.
    3. Publications in the ART database related to relevant QUERI projects. In addition to using ART database, articles were identified by experts or reference mined.

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    Self-management Strategies for Epilepsy

    Key Questions

    KQ1: For adults with epilepsy, what are the effects of self-management programs on process, clinical outcomes and healthcare utilization?

    KQ2:For adults with epilepsy, what are the most commonly employed components of self-management interventions evaluated in comparative studies?

    (contingent KQ2b): Which epilepsy self-management intervention components are most effective?

    KQ3: What are the identified facilitators and barriers that impact the adoption of self-management programs for adults with epilepsy in large-scale health systems such as the VA?

    PICOTS

    Population(s): Adults (age ≥ 18 yo) with new or chronic epilepsy. Family members and/or caregivers of those with epilepsy.

    Interventions: Self-management (SM), defined as interventions that aim to equip patients with skills to actively participate in and take responsibility for the management of epilepsy in order to function optimally through at least knowledge acquisition and a combination of 1 or more of the following: stimulation of independent sign/symptom monitoring, medication management, enhancing problem-solving and decision-making skills for epilepsy treatment management, safety promotion (eg, driving), and changing health behaviors (including stress management, sleep, substance use).

    Comparator: Any, including usual care, attention control, active intervention

    Outcome(s):

    Clinical: Seizure Rate/frequency/Severity; Quality of Life (QOL); Social function/engagement (eg, days work missed, or validated measure); Psychological symptoms (ie, distress, depressive or anxiety symptoms); Safety outcomes (eg, motor vehicle accidents); Medication toxicity

    Process: Epilepsy Self-efficacy and Epilepsy Self-management scales; Medication adherence; Disease knowledge

    Utilization: Acute care or emergency department visits; Hospitalization; or Outpatient specialty visits for epilepsy

    General Search Strategy

    We will conduct a primary search from inception to the current date of MEDLINE® (via PubMed®), PsycINFO, and CINAHL. We will use a combination of MeSH keywords and selected free-text terms to search titles and abstracts. To ensure completeness, search strategies will be developed in consultation with an expert librarian. We will also search the grey literature specifically by conducting a targeted search in clinicaltrials.gov and through hand-searches of the references from select high-quality systematic reviews and exemplar studies identified during the topic development process and as identified by our stakeholders.

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    Guided Imagery, Biofeedback, and Hypnosis

    Key Questions

    • KQ1: In which populations has guided imagery been examined, and what is the evidence of effectiveness and harms in each of these populations?
    • KQ2: In which populations has biofeedback been examined, and what is the evidence of effectiveness and harms in each of these populations?
    • KQ3:In which populations has hypnosis been examined, and what is the evidence of effectiveness and harms in each of these populations?

    PICOTS

    Population(s): Adults (18+) receiving an intervention of interest for any health condition. Children and adolescents are excluded. Exclude studies of healthy volunteers.

    Intervention(s): Guided imagery (also “guided meditation,” “yoga nidra,” “mental practice,” “mental rehearsal,” “Katathym-imaginative Psychotherapy,” “autogenic training,” and “integrative restoration”). Studies of guided imagery as part of a complex or multicomponent intervention are excluded.

    Biofeedback (also “neurofeedback,” and “neurotherapy”). Studies of biofeedback as part of a complex or multicomponent intervention are excluded.

    Hypnosis (also “hypnotherapy”). Studies of hypnosis as part of a complex or multicomponent intervention are excluded.

    Comparator: Systematic reviews and meta-analyses of RCTs comparing an intervention of interest to usual care, placebo, or another intervention

    Outcome(s): Effect on diagnosis-related symptoms; harms

    Setting(s): All health care settings

    General Search Strategy

    Search strategies will be developed in consultation with a research librarian, and will be peer reviewed by a second research librarian using the instrument for Peer Review of Search Strategies. We will conduct a review of the literature by systematically searching, reviewing, and analyzing the scientific evidence as it pertains to the research questions. To identify relevant systematic reviews/meta-analyses, we will begin by searching Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily and Ovid MEDLINE, Ovid PsycINFO, CINAHL, Epistomonikos, and Ovid EBM Reviews Cochrane Database of Systematic Reviews (CDSR, DARE, HTA, Cochrane CENTRAL, etc). We will search all available years of publication from database inception (1946 for Ovid MEDLINE®) through March 2018. To identify additional reviews, we will review the bibliographies of relevant reviews of reviews, search the review registry Prospero for completed reviews, and query subject matter experts.

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