Enhancing Equitable and Effective (E-3) Post Traumatic Stress Disorder (PTSD) Disability Assessment

Study Overview
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Brief Summary
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This project evaluated the impact of semi-structured, standardized interviews on the initial PTSD C&P on the examination.

Detailed Description
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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.

Official Title
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Enhancing Equitable and Effective PTSD Disability Assessment

Conditions
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Post-Traumatic Stress Disorder

Intervention / Treatment
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* Behavioral: CAPS/WHODAS
* Behavioral: Nonstructured Interview


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Veterans referred to VHA for an Initial PTSD Compensation and Pension Examination Informed consent Exclusion Criteria: Mentally impaired, not able to give informed consent English speaking

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: CAPS/WHODAS<br>PTSD assessed using Clinical Assessment of PTSD Symptoms (CAPS) and WHODAS functional impairment structured evidence-based interview | Behavioral: CAPS/WHODAS<br>* CAPS/WHODAS structured clinical PTSD interview<br>|
| Active Comparator: Nonstructured Interview<br>Usual clinical interview to assess PTSD, without CAPS or WHODAS | Behavioral: Nonstructured Interview<br>* Usual PTSD clinical PTSD interview, not CAPS or SCID<br>* Other names: Usual Clinical Interview;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | 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 | 

Secondary Outcome Measures

| Outcome Measure | 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 | 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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Disability Examination, Clinician Administered PTSD Scale, Quality of Care