Final Research Report
View this project's final research report.
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Article Highlight: Matching patients seeking mental health care with therapists who have a good track record of treating the patients' particular needs and concerns resulted in better outcomes than not matching patients, according to findings from this PCORI-funded study recently published in JAMA Psychiatry. Therapists tend to have areas of greatest experience and skill, the research team noted. Matched patients had larger reductions in both specific and general mental health symptoms and impaired functioning and reported feeling less distressed. The match system used in the study required minimal disruption within the mental health care system in which it was tested.
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Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
Reviewers asked whether the intervention effect that the researchers reported could have been due to patient characteristics rather than to the match system connecting patients to therapists with noted skill in treatment patients like them. The researchers admitted that their naturalistic study design meant that they had little control over therapists’ workloads and therefore over how many patients in each condition the therapists could take on. However, the researchers controlled for within-therapist factors to account for therapist effectiveness, and each participating therapist saw patients who were matched to them and patients who were not matched. With these controls, the researchers stated with confidence that a given therapist achieves better outcomes when treating a matched patient than a nonmatched patient.
To further test the reviewers’ concerns regarding the effect of therapist skill on achieving the stated results, the researchers conducted additional analyses to test whether the most effective therapists were more likely to treat matched patients than nonmatched patients. They found that in aggregate the top third most effective therapists saw about the same number of patients in each group. The researchers did acknowledge the possibility that therapist effectiveness contributed to the overall treatment effect in their report.
The reviewers questioned whether this study actually addressed mental illness because the patients in the study were not identified with mental health diagnoses. They asked the researchers to indicate how many patients would be identified as having behavioral health concerns rather than diagnosable mental illness. The researchers disagreed with this characterization of the study sample, saying that a mental illness diagnosis does not correlate with more severe problems. The researchers clarified in the report that the patients’ problem ratings were, on average, higher than 95 percent of the population, indicating significant mental health problems.
Conflict of Interest Disclosures
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