团队功能和工作量对创伤聚焦循证心理疗法可持续性的影响。
The Influence of Team Functioning and Workload on Sustainability of Trauma-Focused Evidence-Based Psychotherapies.
机构信息
Dr. Mohr is with the Center for Healthcare Organization and Implementation Research and Dr. Kehle-Forbes is with the National Center for PTSD Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) Boston Healthcare System, Boston. Dr. Mohr is also with the School of Public Health, Boston University, Boston. Dr. Kehle-Forbes is also with the Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, where Mr. Orazem, Dr. Noorbaloochi, Ms. Clothier, and Dr. Sayer are affiliated. Dr. Noorbaloochi and Dr. Sayer are also with the Department of Medicine, University of Minnesota, Minneapolis. Dr. Rosen, Dr. Eftekhari, Dr. Crowley, and Dr. Ruzek are with the Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California. Dr. Rosen and Dr. Ruzek are also with the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California. Dr. Schnurr and Dr. Bernardy are with the Executive Division, National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont, and also with the Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Chard is with the PTSD Division, Cincinnati VA Medical Center, Cincinnati. Dr. Cook is with the Evaluation Division, National Center for PTSD, and with the Yale University School of Medicine, both in New Haven, Connecticut.
出版信息
Psychiatr Serv. 2018 Aug 1;69(8):879-886. doi: 10.1176/appi.ps.201700432. Epub 2018 May 25.
OBJECTIVE
It has been over a decade since the U.S. Department of Veterans Affairs (VA) began formal dissemination and implementation of two trauma-focused evidence-based psychotherapies (TF-EBPs). The objective of this study was to examine the sustainability of the TF-EBPs and determine whether team functioning and workload were associated with TF-EBP sustainability.
METHODS
This observational study used VA administrative data for 6,251 patients with posttraumatic stress disorder (PTSD) and surveys from 78 providers from 10 purposefully selected PTSD clinical teams located in nine VA medical centers. The outcome was sustainability of TF-EBPs, which was based on British National Health System Sustainability Index scores (possible scores range from 0 to 100.90). Primary predictors included team functioning, workload, and TB-EBP reach to patients with PTSD. Multiple linear regression models were used to examine the influence of team functioning and workload on TF-EBP sustainability after adjustment for covariates that were significantly associated with sustainability.
RESULTS
Sustainability Index scores ranged from 53.15 to 100.90 across the 10 teams. Regression models showed that after adjustment for patient and facility characteristics, team functioning was positively associated (B=9.16, p<.001) and workload was negatively associated (B=-.28, p<.05) with TF-EBP sustainability.
CONCLUSIONS
There was considerable variation across teams in TF-EBP sustainability. The contribution of team functioning and workload to the sustainability of evidence-based mental health care warrants further study.
目的
自美国退伍军人事务部（VA）开始正式传播和实施两种创伤为重点的循证心理疗法（TF-EBP）以来，已经过去了十多年。本研究的目的是检验 TF-EBP 的可持续性，并确定团队功能和工作量是否与 TF-EBP 的可持续性相关。
方法
本观察性研究使用了 VA 管理数据，其中包括 6251 名患有创伤后应激障碍（PTSD）的患者，以及来自 10 个 PTSD 临床团队的 78 名提供者的调查，这 10 个团队是从 9 个 VA 医疗中心中精心挑选的。研究结果是 TF-EBP 的可持续性，该可持续性是基于英国国家卫生系统可持续性指数评分（可能的评分范围为 0 至 100.90）。主要预测因素包括团队功能、工作量以及向 PTSD 患者提供 TF-EBP 的范围。使用多元线性回归模型来检验团队功能和工作量对 TF-EBP 可持续性的影响，这些影响是在对与可持续性显著相关的协变量进行调整后得出的。
结果
10 个团队的可持续性指数评分范围从 53.15 到 100.90。回归模型显示，在调整了患者和机构特征后，团队功能与 TF-EBP 可持续性呈正相关（B=9.16，p<.001），工作量与 TF-EBP 可持续性呈负相关（B=-.28，p<.05）。
结论
在 TF-EBP 的可持续性方面，各个团队之间存在相当大的差异。团队功能和工作量对循证心理健康护理的可持续性的贡献值得进一步研究。
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