Houston andD Center for Innovations in Quality

Houston, TX, United States

Houston andD Center for Innovations in Quality

Houston, TX, United States
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Calleo J.,Houston andD Center for Innovations in Quality | Calleo J.,Michael bakey Veterans Affairs Medical Center | Calleo J.,Baylor College of Medicine | Williams J.R.,Biogen Idec | And 25 more authors.
Journal of Parkinson's Disease | Year: 2013

Background: In patients with Parkinson's disease (PD), depressive symptom rating scales facilitate identification of depressive disorders, which are common and disabling. Anxiety disturbances in PD, which lack valid assessment scales, frequently co-occur with PD-depression, are under-recognized, and require different interventions than depressive disorders. Whether high anxiety rates in PD confound depression scale performance or if any depression scales also predict anxiety disturbances is not known. Objective: To test the impact of co-occurring anxiety disorders on psychometric properties of depression rating scales in depressed PD patients and compare disability between PD patients with anxiety, depression, and comorbid anxiety and depressive disorders. Methods: PD subjects (n = 229) completed self-report and clinician-administered depression scales. Receiver operating characteristic curves were developed to estimate psychometric properties of each scale in those with depression alone, anxiety alone, and comorbid depression and anxiety. Between-group differences on all measures were examined. Results: Comorbid anxiety did not affect the psychometric properties of any scale when identifying depressive disorders, but is associated with greater symptom severity and disability. Depression-scale scores were not significantly different between subjects with anxiety disorders only and those without depressive or anxiety diagnoses. Conclusions: Co-occurring anxiety disorders do not impact performance of depression rating scales in depressed PD patients. However, depression rating scales do not adequately identify anxiety disturbances alone or in patients with depression. © 2013 -IOS Press and the authors.

Lindsay J.A.,VA South Central Mental Illness Research | Lindsay J.A.,Michael bakey Va Medical Center | Lindsay J.A.,Houston andD Center for Innovations in Quality | Lindsay J.A.,Baylor College of Medicine | And 13 more authors.
Telemedicine and e-Health | Year: 2015

Abstract Background: Increasing access to psychotherapy for posttraumatic stress disorder (PTSD) is a primary focus of the Department of Veterans Affairs (VA) healthcare system. Delivery of treatment via video telehealth can expand availability of treatment and be equally effective as in-person treatment. Despite VA efforts, barriers to establishing telehealth services remain, including both provider acceptance and organizational obstacles. Thus, development of specific strategies is needed to implement video telehealth services in complex healthcare systems, like the VA. Materials and Methods: This project was guided by the Promoting Action on Research Implementation in Health Services framework and used external facilitation to increase access to psychotherapy via video telehealth. The project was conducted at five VA Medical Centers and their associated community clinics across six states in the South Central United States. Results: Over a 21-month period, 27 video telehealth clinics were established to provide greater access to evidence-based psychotherapies for PTSD. Examination of change scores showed that participating sites averaged a 3.2-fold increase in unique patients and a 6.5-fold increase in psychotherapy sessions via video telehealth for PTSD. Differences between participating and nonparticipating sites in both unique patients and encounters were significant (p=0.041 and p=0.009, respectively). Two groups emerged, separated by degree of engagement in the facilitation intervention. Facilitation was perceived as useful by providers. Conclusions: To our knowledge, this is the first prospective study of external facilitation as an implementation strategy for telehealth. Our findings suggest that external facilitation is an effective and acceptable strategy to support providers as they establish clinics and make complex practice changes, such as implementing video telehealth to deliver psychotherapy. © Copyright 2015, Mary Ann Liebert, Inc.

Hundt N.E.,Houston andD Center for Innovations in Quality | Hundt N.E.,Baylor College of Medicine | Hundt N.E.,United Virtual | Calleo J.S.,Baylor College of Medicine | And 6 more authors.
Psychology and Psychotherapy: Theory, Research and Practice | Year: 2016

We examined symptoms and use of cognitive-behavioural therapy (CBT) skills during treatment for 60 outpatients receiving group CBT for depression. Depression symptoms decreased significantly and frequency of skills use increased significantly during treatment, and increases in skills use from pre-treatment to mid-treatment predicted changes in depression at post-treatment. Practitioner points Patients who report infrequent use of skills may be at risk for treatment non-response, which can provide an early warning sign for clinicians. Potential interventions include more psychoeducation about the treatment rationale to increase 'buy-in' or motivational interviewing to increase skills use. © Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

Cully J.A.,Houston andD Center for Innovations in Quality | Cully J.A.,Michael bakey Va Medical Center | Cully J.A.,Baylor College of Medicine | Cully J.A.,Education Research and Clinical Center | And 23 more authors.
BMC Health Services Research | Year: 2014

Background: Depression and diabetes cause significant burden for patients and the healthcare system and, when co-occurring, result in poorer self-care behaviors and worse glycemic control than for either condition alone. However, the clinical management of these comorbid conditions is complicated by a host of patient, provider, and system-level barriers that are especially problematic for patients in rural locations. Patient-centered medical homes provide an opportunity to integrate mental and physical health care to address the multifaceted needs of complex comorbid conditions. Presently, there is a need to not only develop robust clinical interventions for complex medically ill patients but also to find feasible ways to embed these interventions into the frontlines of existing primary care practices. Methods/design. This randomized controlled trial uses a hybrid effectiveness-implementation design to evaluate the Healthy Outcomes through Patient Empowerment (HOPE) intervention, which seeks to simultaneously address diabetes and depression for rural veterans in Southeast Texas. A total of 242 Veterans with uncontrolled diabetes and comorbid symptoms of depression will be recruited and randomized to either the HOPE intervention or to a usual-care arm. Participants will be evaluated on a host of diabetes and depression-related measures at baseline and 6- and 12-month follow-up. The trial has two primary goals: 1) to examine the effectiveness of the intervention on both physical (diabetes) and emotional health (depression) outcomes and 2) to simultaneously pilot test a multifaceted implementation strategy designed to increase fidelity and utilization of the intervention by coaches interfacing within the primary care setting. Discussion. This ongoing blended effectiveness-implementation design holds the potential to advance the science and practice of caring for complex medically ill patients within the constraints of a busy patient-centered medical home. Trial registration. Behavioral Activation Therapy for Rural Veterans with Diabetes and Depression: NCT01572389. © 2014Cully et al.; licensee BioMed Central Ltd.

Hundt N.E.,Houston andD Center for Innovations in Quality | Hundt N.E.,Baylor College of Medicine | Hundt N.E.,United Virtual | Amspoker A.B.,Houston andD Center for Innovations in Quality | And 14 more authors.
Journal of Anxiety Disorders | Year: 2014

The current study is a secondary analysis of data from a randomized controlled trial of CBT for late-life GAD (Stanley et al., 2014) which provided an opportunity to examine predictors of outcome among those who received CBT. Participants were 150 older adults who were randomized to receive 10 sessions of CBT. Completer analyses found that homework completion, number of sessions attended, lower worry severity, lower depression severity, and recruitment site predicted 6-month worry outcome on the PSWQ-A, whereas homework completion, credibility of the therapy, lower anxiety severity, and site predicted 6-month anxiety outcome on the STAI-T. In intent-to-treat multivariate analyses, however, only initial worry and anxiety severity, site, and number of sessions completed predicted treatment outcome. These results are largely consistent with predictors of outcome in younger adults and suggest that lower initial symptom severity and variables consistent with greater engagement in treatment predict outcome. © 2014.

Kong J.,Baylor College of Medicine | Anaya D.A.,Baylor College of Medicine | Anaya D.A.,Houston andD Center for Innovations in Quality
International Journal of Surgery Case Reports | Year: 2015

Introduction Giant cavernous hemangiomas are the most common tumors of the liver, ocurring in up to 20% of the general population. Given their benign course, asymptomatic nature and slow growth rate, treatment is rarely indicated. The case presented herein is unique as it describes an uncommon presentation of this common tumor and the circumstances in which surgical treatment is beneficial. Presentation of case We present a case of a 66 year-old patient with prostate cancer referred for evaluation of a massive 37 cm giant liver hemangioma, extending into the pelvis and in the planned field of radiation for prostate cancer, exhibiting rapid growth, and associated with significant symptomatology. Given these clinical characteristics, the patient was offered surgery and underwent a left trisectionectomy with an uneventful recovery. The patient's symptoms resolved and he was able to complete radiation to the pelvis. Discussion In the context of an unusual presentation, this case presentation reviews the typical clinical and imaging characteristics of giant liver hemangiomas and expands on the current indications for treatment, emphasizing the role of enucleation and resection for patients meeting appropriate indications. Conclusion Although liver hemangiomas are extremely common, surgical treatment is rarely required. With appropriate indications, and when enucleation is not feasible or ideal, major liver resection is a safe alternative approach with excellent outcomes when performed in the right setting.

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