Utilizing Health Information Technology to Improve Health Care Quality (Florida)

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Summary:

Anxiety disorders are common among children, and untreated symptoms can have a profound effect on later functioning. Cognitive behavioral therapy (CBT) is the gold standard to treat anxiety in youth, but dissemination of CBT is limited. The overall objective of this project was to examine the effectiveness, feasibility, and acceptability of an established computer-assisted cognitive behavioral therapy program (CCBT) among anxious children at community mental health centers.

The specific aims of the project were as follows:

  • Assess a CCBT protocol for clarity, completeness, and feasibility in a pilot study of children ages 7-13 years, with clinically significant anxiety within a community mental health center setting. 
  • Conduct a randomized controlled trial to determine the efficacy of the CCBT protocol, relative to active patient-directed intervention (i.e., treatment as usual) within a community mental health center population. 

For the first aim, the investigators examined a CCBT protocol among youth aged 7-13 years to determine its acceptability and feasibility. They collected feedback from consumers, providers, and administrators to help refine assessment and treatment delivery protocols and address barriers in preparation for the randomized trial. One hundred youth were randomized to receive either the CCBT program or treatment as usual to evaluate the efficacy of CCBT with clinically significant anxiety disorders and to examine whether CCBT resulted in improved global functioning and reduced child- and parent-rated anxiety symptoms relative to standard care.

Those randomized to the CCBT had more favorable outcomes on primary anxiety outcomes compared to those in the treatment as usual arm. High levels of satisfaction with the program were reported among participants and staff. These data provide support that CCBT is an efficacious treatment for anxious youth when used within community mental centers.

Utilizing Health Information Technology to Improve Health Care Quality - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology (IT) to Improve Health Care Quality (R18)
  • Grant Number: 
    R18 HS 018665
  • Project Period: 
    September 2011 – September 2014
  • AHRQ Funding Amount: 
    $1,186,782
  • PDF Version: 
    (PDF, 270.88 KB)

Summary: Childhood anxiety disorders affect a significant percentage of youth and cause substantial distress and impairment. Cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) monotherapies are effective and comparable treatments of childhood-onset anxiety disorders. While CBT lacks the side effects of SSRI therapy, there are practical concerns of dissemination due to the limited availability of trained clinicians; limited treatment center and therapist locations; travel expenses; and immediate treatment costs. Accordingly, there has been a growing body of research on the practicality and efficacy of computerized cognitive-behavioral therapy (CCBT).

This project is evaluating the feasibility and preliminary efficacy of disseminating a CCBT protocol to community mental health centers. An efficacious CCBT protocol could contribute to public health efforts to address the mental health needs of a large number of children diagnosed with anxiety disorders.

The project consists of a two-phase trial that evaluates the feasibility of implementing a patient-centered intervention in community mental health centers, followed by an efficacy trial. In Phase I, an open trial of CCBT that focuses on feasibility issues of providing this intervention in community mental health centers will be completed. The CCBT protocol will be tested in youth to determine its acceptability and feasibility. Assessment and treatment delivery protocols will be refined; feedback will be obtained from patients, families, therapists, and organizational consultants; and barriers will be identified and addressed in preparation for the Phase II trial.

In Phase II, a randomized controlled trial will: 1) compare CCBT to treatment-as-usual (TAU) in order to evaluate the acute efficacy of CCBT relative to TAU in youth with clinically significant anxiety disorders; 2) determine whether CCBT results in greater short-term treatment efficacy relative to TAU after treatments are withdrawn; 3) examine whether CCBT results in improved global functioning and reduced child and parent anxiety symptoms relative to TAU; and 4) examine whether CCBT is associated with greater satisfaction and consumer acceptability than TAU.

While this study is being coordinated by a research team at the University of South Florida Rothman Center for Neuropsychiatry, recruitment will take place at three community mental health centers that serve families of lower socioeconomic status throughout Florida.

Specific Aims:

  • Assess CCBT for clarity, completeness, and feasibility in a pilot study of 18 children ages 7-13 years, with significant involvement from caregivers. (Achieved)
  • Conduct a randomized controlled trial of 110 children to determine the efficacy of CCBT relative to TAU. (Achieved)
  • Examine factors that may predict CCBT outcome. (Ongoing)

2012 Activities: During this period Dr. Storch held regularly scheduled weekly phone meetings with the University of South Florida research staff and investigators, site coordinators, and therapists to discuss various aspects of the research plan (e.g., manual development, protocol implementation, study issues). These calls included: 1) a call for the site therapists and lead therapy consultant to discuss treatment procedures, issues, and individual cases once recruitment begins; 2) a call for site coordinators and overall project coordinator to discuss concerns of implementing the study, recruitment, and participant tracking issues; 3) a call to facilitate discussion among all study team members; and 4) a monthly call held among study team members, site directors, and study consultants to discuss overall study progress and concerns.

The CCBT protocol was tested to determine its acceptability and feasibility. Assessment and treatment delivery protocols were refined; feedback was obtained from patients, families, therapists, and organizational consultants in the context of focus groups; and barriers were identified and addressed in preparation for the Phase II trial. Recruitment for the CCBT pilot was initiated at sites.

Two manuscripts were developed, one of which was revised and resubmitted. As last self-reported in the AHRQ Research Reporting System, project progress and activities are completely on track and spending is on target.

Preliminary Impact and Findings: The project has no findings to date.

Target Population: Chronic Care*, Mental Health/Depression, Pediatric*

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Implementation and Use

* This target population is one of AHRQ’s priority populations.

Utilizing Health Information Technology to Improve Health Care Quality - 2011

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology (IT) to Improve Health Care Quality (R18)
  • Grant Number: 
    R18 HS 018665
  • Project Period: 
    September 2011 - September 2014
  • AHRQ Funding Amount: 
    $1,186,782
  • PDF Version: 
    (PDF, 193.54 KB)

Summary: Childhood anxiety disorders affect a significant percentage of youth and cause substantial distress and impairment. Cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) monotherapies are effective and comparable treatments of childhood-onset anxiety disorders. While CBT lacks the side effects of SSRI therapy, there are practical concerns of dissemination due to the limited availability of trained clinicians; limited treatment center/therapist locations; travel expenses; and immediate treatment costs. Accordingly, there has been a growing body of research on the practicality and efficacy of computerized cognitive-behavioral therapy (CCBT).

This project is evaluating the feasibility and preliminary efficacy of disseminating a CCBT protocol to community mental health centers. An efficacious CCBT protocol could contribute to public health efforts to address the mental health needs of a large number of children diagnosed with anxiety disorders.

The project consists of a two-phase trial that evaluates the feasibility of implementing a patient-centered intervention in community mental health centers, followed by an efficacy trial. In Phase I, an open trial of CCBT that focuses on feasibility issues of providing this intervention in community mental health centers will be completed. The CCBT protocol will be tested in 18 youth, age 7-13 years, to determine its acceptability and feasibility. Assessment and treatment delivery protocols will be refined; feedback will be obtained from patients, families, therapists, and organizational consultants; and barriers will be identified and addressed in preparation for the Phase II trial.

In Phase II, a randomized controlled trial will: 1) compare CCBT to treatment-as-usual (TAU) in order to evaluate the acute efficacy of CCBT relative to TAU in youth with clinically significant anxiety disorders; 2) determine whether CCBT results in greater short-term treatment efficacy relative to TAU after treatments are withdrawn; 3) examine whether CCBT results in improved global functioning and reduced child and parent anxiety symptoms relative to TAU; and 4) examine whether CCBT is associated with greater satisfaction and consumer acceptability than TAU.

While this study is being coordinated by a research team at the University of South Florida Rothman Center for Neuropsychiatry, recruitment will take place at three community mental health centers that serve families of lower socioeconomic status throughout Florida.

Specific Aims:

  • Assess CCBT for clarity, completeness, and feasibility in a pilot study of 18 children ages 7-13 years, with significant involvement from caregivers. (Ongoing)
  • Conduct a randomized controlled trial of 110 children to determine the efficacy of CCBT relative to TAU. (Upcoming)
  • Examine factors that may predict CCBT outcome. (Upcoming)

2011 Activities: In its first quarter of its first year, the project focused upon start-up activities. During regularly scheduled phone meetings, Dr. Storch, University of South Florida research staff and investigators, and site coordinators and therapists discussed varying aspects of the research plan. The University of South Florida obtained site subcontracts for each performance site. These subcontracts outlined the scope of work required of each site to receive payment.

Changes to the protocol, informed consent, and related study forms were finalized, submitted to, and approved by the institutional review board (IRB). IRB study approval was obtained from the performance sites. The site therapists, coordinators, and study investigators completed IRB ethics and other required training.

A 2-day training for all study coordinators, therapists, research investigators, and consultants was organized at the University of South Florida. The training explained the procedures for implementing the protocol, both from a logistical (organization, participant tracking, safety monitoring, etc.) and application perspective (treatment and assessment protocols). Therapists were trained to implement the treatment protocol.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are completely on track and project budget spending is roughly on target.

Preliminary Impact and Findings: The project has no findings to date.

Target Population: Chronic Care*, Mental Health/Depression, Pediatric*

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Implementation and Use

* This target population is one of AHRQ's priority populations.

Utilizing Health Information Technology to Improve Health Care Quality - Final Report

Citation:
Storch E. Utilizing Health Information Technology to Improve Health Care Quality - Final Report. (Prepared by the University of South Florida under Grant No. R18 HS018665). Rockville, MD: Agency for Healthcare Research and Quality, 2015. (PDF, 395.03 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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Document Type: 
Medical Condition: 
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