Development of a Quality Measure for Adults with Post-Traumatic Stress Disorder. A. Environmental Scan of PTSD Treatments and Measures

05/01/2019

After initial meetings with ASPE and NIMH to discuss priority measurement areas within the broad field of PTSD care and target populations for this quality measure development effort, we conducted a scan of research literature and clinical guidelines to identify evidence-based treatments for PTSD. The scan drew on systematic reviews (including meta-analyses), primary research studies, evidence-based clinical guidelines, and the recommendations of taskforces, including the Institute of Medicine's taskforce on the treatment of PTSD (Institute of Medicine 2008, 2012).

TABLE II.1. Sources for Environmental Scan of PTSD Research Studies, Clinical Guidelines, and Quality Measures
Source of Information Data Sources Selected Search Terms
Research studies
  • PubMed
  • Cochrane Database of Systematic Reviews
  • PsychINFO
  • National Center for the Study of PTSD website
PTSD, trauma, psychotherapy, medication, drugs, pharmacotherapy, treatment, care, services
Clinical guidelines
  • National Guideline Clearinghouse
  • Guidelines International Network
  • PubMed
  • Professional websites, for example, the American Psychiatric Association
Psychology, psychiatry, adult and trauma, anxiety disorders, stress
Quality measures
  • CQAIMH's National Inventory of Mental Health Quality Measures database
  • NQF Quality Positioning System
  • PILOTS database
  • NQMC
  • Searches of behavioral health quality improvement initiatives, for example, the SAMHSA's National Outcomes Measures
  • Conversations with PTSD experts
Mental, behavioral, psychiatry, psychology, PTSD, trauma, anxiety, depression, substance, and patient experience, diabetes, cardiovascular

To identify relevant studies and guidelines, we developed search terms to guide this information gathering effort and identified data sources for the information (see Table II.1). We limited the scan to studies and guidelines in English and related to the treatment of PTSD in adults. We created detailed Excel spreadsheets with summaries of the treatment or intervention, the outcome measure(s), the results, and the study design and grading of the study design. We used this information to identify evidence-based treatments for adults with PTSD for which there was the strongest scientific evidence. Briefly, the results of the environmental scan identified strong evidence in support of the effectiveness of cognitive behavioral therapy (CBT), particularly exposure therapies, in the treatment of adults with PTSD. The scan also found clinical guideline support for -- but conflicting interpretations of -- the research on the effectiveness of selective serotonin reuptake inhibitors (SSRIs) and insufficient research evidence in adults with PTSD regarding the effectiveness of support services and care coordination (see Appendix A and the Institute of Medicine 2008, 2012).