Piloting Acute Care to Primary Care Linkage of Safety Net Patients (TSOS III)
調査の概要
状態
条件
詳細な説明
The investigators plan to implement a pilot linkage program in which trauma center based care facilitators will use a population-based recruitment strategy to facilitate outpatient follow-up for acutely injured trauma center inpatients and emergency department patients. All patients recruited into the trial will be low income patients with one or more of the following characteristics: being uninsured, low income older adults, low income mothers, and other high risk individuals who lack health insurance. Patients will be linked for care to one of the community health centers participating in Washington State.
In phase I, patients will be recruited from the trauma center inpatient trauma surgery service and emergency departments. In phase one, no randomization will occur; patients will be linked to one of the community health centers. Patients who consent to the protocol will be assessed in the surgical inpatient units or emergency department. After the baseline assessment, all patients will be immediately assigned a bachelor's, MSW, or RN level care manager. The care managers will elicit and address posttraumatic concerns, and attempt linkage of patients to community programs. Care managers may also deliver motivational interviewing and cognitive behavioral therapy interventions. Patient may also be linked to psychopharmacologic interventions targeting PTSD. Follow-up assessments will occur in the weeks and months after the injury and will assess patterns of health service utilization and symptomatic outcomes. Phase I will establish the feasibility of recruitment and follow-up, acceptability of care management for patients, as well as the pragmatics of linkage to community programs.
Piloting in phase II will depend on the results of phase I; the phase II pilot will build and extend upon phase I. In phase II, patients will be randomized to either intervention or control conditions. Patients randomized to the intervention condition will be met by a care manager who may address patients' initial needs and concerns. Care managers may also deliver Motivational Interviewing and Cognitive Behavioral Therapy interventions. Patients may also be linked to psychopharmacologic interventions targeting PTSD. The care manager will attempt to link patients to participating community health centers. Linkages may occur by the telephone, or through web-based clinical registry tools that are under development by the intervention team. Some linkages may occur in person. To determine if intervention patients are successfully linked more frequently than controls, all patients will be followed from the time of designation at hospital admission to outpatient primary care appointments. Follow-up outcome assessments will occur in the weeks and months post-injury and will includes assessments of patterns of health service utilization, function, and symptomatic outcomes.
研究の種類
入学 (実際)
段階
- フェーズ 1
連絡先と場所
研究場所
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Washington
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Seattle、Washington、アメリカ、98104
- Harborview Medical Center
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- English-speaking
- Admitted to Harborview Medical Center with injuries sufficiently severe enough to require inpatient admission
- Experienced a traumatic injury
- Exhibits symptoms of PTSD while in the hospital ward
- Low-income
Exclusion Criteria:
- History of head, spinal, or other injury that may prevent participation in the ward interview
- Requires immediate intervention due to conditions such as self-inflicted injury, active psychosis, or active mania
- Currently incarcerated
- Likely to face criminal charges
- Lives outside of the state of Washington
- Not low-income
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:ランダム化
- 介入モデル:階乗代入
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
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実験的:Stepped care
Combination of behavioral therapy and drug therapy
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Behavioral therapy includes standard cognitive behavioral therapy, with an emphasis on behavioral activation.
Treatment is administered on the basis of the participants' individual needs and may continue for up to 12 months.
他の名前:
Motivational interviewing is designed to address alcohol and drug use.
他の名前:
Participants assigned to receive the combination therapy may receive one or more of the following medications based on their individual needs: fluoxetine, sertraline, paroxetine, buspirone, propranolol, trazodone, and any of the benzodiazepines.
Participants may begin receiving medication immediately or anytime within the 12 months post-injury.
Form, dosage, frequency, and duration depend on patient need, but all are prescribed in accordance with standards of care.
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アクティブコンパレータ:Standard care provided to injured trauma survivors
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Standard care control includes the usual treatment for injured trauma survivors
他の名前:
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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Change From Baseline Alcohol Use Disorders Identification at 1 Month
時間枠:Baseline, Up to 12 months after injury
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The investigators will use the Alcohol Use Disorders Identification Test (AUDIT) as a continuous measure.
The 10-item scale score ranges from 0-40, with higher values indicating a worse outcome.
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Baseline, Up to 12 months after injury
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Change From Baseline PTSD Checklist Civilian (PCL-C) at 1 Month
時間枠:Baseline, Up to 12 months after injury
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The investigators will use the PTSD Checklist - Civilian (PCL-C).
The scoring of the scale ranges from a minimum of 17 to a maximum of 85, with higher scores indicating a worse outcome.
The measure can also provide a rating of symptoms consistent with a diagnosis of PTSD.
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Baseline, Up to 12 months after injury
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Change in Functional Status at 1 Month
時間枠:Baseline, Up to 12 months after injury
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The investigators will use the Medical Outcomes Study Short Form healthy survey (MOS SF-12/36) physical components summary to assess physical function.
The minimum and maximum scores are 0-100 with higher scores representing a better outcome.
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Baseline, Up to 12 months after injury
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Increased Satisfaction With Global Care
時間枠:Up to 12 months after injury
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Assessed using the Posttraumatic Growth Inventory (PTGI) and Satisfaction with Care (NSCOT)
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Up to 12 months after injury
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Injury Relapse
時間枠:Up to 5 years after injury
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Assessed using Healthcare Utilization Questions (NSCOT)
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Up to 5 years after injury
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Work, Disability, and Legal Outcomes
時間枠:Up to 12 months after injury
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Assessed using Work, Disability and Legal (NSCOT) and Sheehan Disability Scale (SDS)
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Up to 12 months after injury
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協力者と研究者
スポンサー
出版物と役立つリンク
一般刊行物
- Zatzick D, Roy-Byrne P, Russo J, Rivara F, Droesch R, Wagner A, Dunn C, Jurkovich G, Uehara E, Katon W. A randomized effectiveness trial of stepped collaborative care for acutely injured trauma survivors. Arch Gen Psychiatry. 2004 May;61(5):498-506. doi: 10.1001/archpsyc.61.5.498.
- Zatzick DF, Roy-Byrne P, Russo JE, Rivara FP, Koike A, Jurkovich GJ, Katon W. Collaborative interventions for physically injured trauma survivors: a pilot randomized effectiveness trial. Gen Hosp Psychiatry. 2001 May-Jun;23(3):114-23. doi: 10.1016/s0163-8343(01)00140-2.
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
心的外傷後ストレス障害の臨床試験
Cognitive Behavioral Therapyの臨床試験
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