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CDA 10-016 – HSR&D Study

 
CDA 10-016
Treatment Variation and Treatment Effectiveness in Veterans with PTSD
Thad Abrams MD
Iowa City VA Health Care System, Iowa City, IA
Iowa City, IA
Funding Period: February 2011 - January 2016

BACKGROUND/RATIONALE:
The use of the Department of Veterans Affairs (VA) centralized data sources to study the impact of post-traumatic stress disorder (PTSD) on returning veterans' health has become commonplace. Unfortunately, research is hampered by the lack of a well validated method to identify PTSD using the centralized data. Often a singular definition is used to answer different kinds of research questions.

OBJECTIVE(S):
The purpose of this study was to examine the validity of three algorithms tested against medical chart evidence for two different types of basic research questions: 1) which definitions best predict for a diagnosis of PTSD and, 2) which definitions best predict for the receipt of medication treatment for PTSD.

METHODS:
VA centralized data sources were used to identify a random sample (n=136) of veterans nationwide enrolled in VA care in 2006. Using the ICD-9-cm code of 309.81, three administrative data algorithms commonly used in research were used to define half of the study sample with PTSD and the other half without PTSD: 1) one or two outpatient encounters with PTSD, 2) three or more outpatient encounters with PTSD, and 3) one or more inpatient encounter with PTSD. Next, medical records over a three year period (FY 2006 - 2008) were abstracted for each subject by trained psychology research assistants focusing on two relevant clinical judgments: 1) was there evidence of medical documentation of a diagnosis of PTSD, and 2) was there evidence of prescription treatment for PTSD. The two independent raters used a 5 point Likert scale to determine whether or not the providers of record were documenting each of these relevant clinical situations. Sensitivity, specificity, positive and negative predictive (PPV and NPV) values were then calculated across each algorithm for each situation.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
When using VHA administrative data, we recommend tailoring the identification strategy according to the research aims. An ACD approach identifying one or more PTSD outpatient encounters is likely to be sufficient for a diagnosis of PTSD. Assessments for PTSD associated pharmacotherapy require using an ACD approach that identifies veterans with the presence of three or more outpatient PTSD encounters.


External Links for this Project

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PUBLICATIONS:

Journal Articles

  1. Moores K, Gilchrist B, Carnahan R, Abrams T. A systematic review of validated methods for identifying pancreatitis using administrative data. Pharmacoepidemiology and drug safety. 2012 Jan 1; 21 Suppl 1:194-202. [view]
  2. Abrams TE, Vaughan-Sarrazin M, Van der Weg MW. Acute exacerbations of chronic obstructive pulmonary disease and the effect of existing psychiatric comorbidity on subsequent mortality. Psychosomatics. 2011 Sep 1; 52(5):441-9. [view]
  3. Abrams TE, Lund BC, Bernardy NC, Friedman MJ. Aligning clinical practice to PTSD treatment guidelines: medication prescribing by provider type. Psychiatric services (Washington, D.C.). 2013 Feb 1; 64(2):142-8. [view]
  4. Lund BC, Abrams TE, Bernardy NC, Alexander B, Friedman MJ. Benzodiazepine prescribing variation and clinical uncertainty in treating posttraumatic stress disorder. Psychiatric services (Washington, D.C.). 2013 Jan 1; 64(1):21-7. [view]
  5. Abrams TE, Blevins A, Weg MW. Chronic obstructive lung disease and posttraumatic stress disorder: current perspectives. International journal of chronic obstructive pulmonary disease. 2015 Oct 15; 10:2219-33. [view]
  6. Abrams TE, Vaughan-Sarrazin M, Fan VS, Kaboli PJ. Geographic isolation and the risk for chronic obstructive pulmonary disease-related mortality: a cohort study. Annals of internal medicine. 2011 Jul 19; 155(2):80-6. [view]
  7. Abrams TE, Lund BC, Alexander B, Bernardy NC, Friedman MJ. Geographical diffusion of prazosin across Veterans Health Administration: Examination of regional variation in daily dosing and quality indicators among veterans with posttraumatic stress disorder. Journal of rehabilitation research and development. 2015 Sep 1; 52(5):619-27. [view]
  8. Abrams TE, Vaughan-Sarrazin M, Rosenthal GE. Influence of psychiatric comorbidity on surgical mortality. Archives of surgery (Chicago, Ill. : 1960). 2010 Oct 1; 145(10):947-53. [view]
  9. Abrams TE, Vaughan-Sarrazin M, Richardson K, Cram P, Rosenthal GE. Patterns of illness explaining the associations between posttraumatic stress disorder and the use of CT. Radiology. 2013 May 1; 267(2):470-8. [view]
  10. Mawanda F, Wallace RB, McCoy K, Abrams TE. PTSD, Psychotropic Medication Use, and the Risk of Dementia Among US Veterans: A Retrospective Cohort Study. Journal of the American Geriatrics Society. 2017 May 1; 65(5):1043-1050. [view]
  11. Lund BC, Abrams TE, Gravely AA. Rebuttal to Gravely et al. Validity of PTSD diagnoses in VA administrative data: comparison of VA administrative PTSD diagnoses to self-reported PTSD Checklist scores. J Rehabil Res Dev. 2011; 48(1):21-30. Available from: http://www.rehab.research.va.gov/jour/11/481/pdf/gravely.pdf. Journal of rehabilitation research and development. 2011 Dec 7; 48(5):vii-ix. [view]
  12. Kumar N, Liang D, Comellas A, Chu AD, Abrams T. Satellite-based PM concentrations and their application to COPD in Cleveland, OH. Journal of exposure science & environmental epidemiology. 2013 Nov 1; 23(6):637-46. [view]
  13. Mawanda F, Wallace RB, McCoy K, Abrams TE. Systemic and localized extra-central nervous system bacterial infections and the risk of dementia among US veterans: A retrospective cohort study. Alzheimer's & dementia : diagnosis, assessment & disease monitoring. 2016 Sep 10; 4:109-117. [view]
  14. Abrams TE, Vaughan-Sarrazin M, Keane TM, Richardson K. Validating administrative records in post-traumatic stress disorder. International Journal of Methods in Psychiatric Research. 2016 Mar 1; 25(1):22-32. [view]
Journal Other

  1. Abrams TE. Capsule Commentary on McNeely et al., Validation of Self-Administered Single Item Screening Questions (SISQs) for Unhealthy Alcohol and Drug use in Primary Care Patients. Journal of general internal medicine. 2015 Dec 1; 30(12):1845. [view]
  2. Abrams TE. Capsule commentary on Rosenthal et al., A Difference-in-Difference Analysis of Changes in Quality, Utilization and Cost Following the Colorado Multi-Payer Patient-Centered Medical Home Pilot. Journal of general internal medicine. 2016 Mar 1; 31(3):323. [view]
Conference Presentations

  1. Vander Weg MW, Cozad A, Howren MB, Cretzmeyer MT, Scherubel MN, Turvey CL, Grant KM, Abrams T, Katz DA. A Tailored Tobacco Cessation Intervention for Rural Veterans. Poster session presented at: VA Rural Health State of the Science Conference; 2016 Sep 12; Washington, DC. [view]
  2. Abrams T, Lund BC, Alexander B, Bernardy N, Friedman M. Dissemination of Prazosin use for PTSD in the Veterans Health System. Poster session presented at: International Society for Traumatic Stress Studies Annual Symposium; 2014 Nov 4; Miami, FL. [view]
  3. Abrams T, Friedman M. Initial Treatment Variation in Previously Untreated Veterans with PTSD. Poster session presented at: International Society for Traumatic Stress Studies Annual Symposium; 2014 Nov 5; Miami, FL. [view]
  4. Abrams T, Mengeling M, Torner J, Booth B, Sadler AG. Lifetime Sexual Assault and Emergency Room Use: A study examining the temporal relationship of single and repeat assaults on ER use in women Veterans. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA. [view]
  5. Abrams T. Rates of Non-evidenced Based Treatment for Rural Veterans with Post Traumatic Stress Disorder. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2011 May 5; Phoenix, AZ. [view]
  6. Abrams T. Repeated Computerized Tomography Imaging Among Young Veterans With and Without PTSD. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2011 May 5; Phoenix, AZ. [view]
  7. Mawanda F, McCoy K, Wallace R, Abrams T. Systemic Bacterial infections and the Risk of Dementia among U.S. Veterans: A Retrospective Cohort Study. Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA. [view]
  8. Abrams T. VA Career Development Award Workshop. Presented at: Society of General Internal Medicine Annual Meeting; 2012 May 12; Orlando, FL. [view]
  9. Abrams T. Variations in Non-evidence Based Treatment Among Veterans with PTSD. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2011 May 5; Phoenix, AZ. [view]
  10. Abrams T, Richardson KK, Lund BC. Variations in Pharmacotherapy Associated with a Diagnosis of PTSD. Poster session presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 16; National Harbor, MD. [view]


DRA: Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: Technology Development and Assessment, Treatment - Comparative Effectiveness, Treatment - Observational, Prevention
Keywords: none
MeSH Terms: none

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