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A randomized controlled trial, or RCT, is the best way to compare how well different treatments work to improve patients' health. In RCTs, researchers assign patients to treatment groups by chance. But RCTs aren't always an option due to high costs or ethical concerns. In these cases, researchers use other types of study designs such as

• Cohort studies, which look at patients' data over time to see how a treatment affects the risk of a certain health event, such as a heart attack
• Case-control studies, which compare data from patients who did and didn't have a certain health event

These designs often use data from health records to compare treatment results. In these studies, researchers use statistical methods to make results more like results from RCTs. Current methods work well for cohort studies but not for case-control studies.

In this study, the research team created and tested new methods and a guide to analyze case-control studies so that results would be more like results from an RCT.

Based on the state of the scientific evidence, the Sequenced Treatment Effectiveness for Posttraumatic Stress (STEPS) Trial was designed to address three specific aims. The first aim was to quantitatively compare engagement, self-reported PTSD symptom severity (primary outcome), quality of life, and recovery outcomes of primary care patients randomized to initially receive brief psychotherapy (Written Exposure Therapy - WET) or their choice of the three selective serotonin reuptake inhibitors (SSRIs). The second aim was, among patients not responding to initial treatment, to quantitatively compare outcomes of primary care patients randomized to: 1) augment the SSRI with WET, 2) switch from the SSRI to another class of antidepressants (serotonin-norepinephrine reuptake inhibitors - SNRI), or 3) switch from WET to the choice of the three SSRIs. The third specific aim was to quantitatively examine treatment heterogeneity among subgroups of primary care patients receiving pharmacotherapy and psychotherapy, including veterans, women, and those using cannabis.

In a stepped-wedge cluster randomized trial, or SW-CRT, researchers compare new treatments to standard treatments in groups of patients, such as patients at different clinics, to look at the treatments' effectiveness. They assign groups by chance to switch from the standard to new treatment at different time points until all groups have received the new treatment. The different time points to switch treatments are called steps.

SW-CRTs take time and resources. If researchers know they can't collect data on all groups and all steps in a SW-CRT, they can plan to use an incomplete SW-CRT design. In incomplete SW-CRTs, researchers plan the study knowing that some clinics or steps will have missing data. But researchers need better guidance for planning incomplete SW-CRTs that still get accurate results.

Also, current methods for planning how many patients and groups should take part in SW-CRTs don't work well for large studies. They also don't work well with certain types of outcomes, like yes or no outcomes; outcomes that have counts, like number of hospital visits; or continuous outcomes, like a score from 0 to 100.

In this study, the research team developed and tested new methods to design and analyze SW-CRTs with different patterns of planned missing data, large data sets, and different types of outcomes.

Imaging tests, such as X-rays and MRIs, can help find health problems. When assessing how well the tests work, accuracy is important. But other benefits and harms, such as having pain from the test or relieving worry by knowing test results, may also matter to patients.

In this study, the research team wanted to learn what effects of imaging tests matter to patients.

Sometimes a study can get better results using data from different sites. In these cases, researchers may want to share patient data, including personal and private information such as dates of birth and addresses. However, researchers may not want to share data across sites because of worries about patient privacy. Some statistical methods can change patients' sensitive individual data into summary data that hides individuals' personal information. These privacy-protecting methods, or PPMs, make it safe to share data across sites. But researchers don't know if PPMs produce accurate results.

In this study, the research team compared combinations of PPMs with methods that use patients' individual data.

To access the methods, software, and R package, please visit the distributed GitHub.

This study addressed whether it is better to expand the scope of collaborative care programs to treat patients with more complex psychiatric disorders or to facilitate successful referrals to specialty mental health care. The primary objective of this study is to compare Telepsychiatry Collaborative Care (TCC) and Telepsychiatry Enhanced Referral (TER) from the patient and provider perspective. The secondary objective is to determine whether patients not engaging and responding to TER, improve with Phone-Psychiatry Enhanced Referral (PER). There are four specific aims.

Aim #1: To quantitatively compare the treatment experience, engagement, self-reported clinical outcomes, and recovery-oriented outcomes of patients initially randomized to TCC and TER.

Aim #2: For the subset of patients randomized to TER who do not engage in treatment and are still symptomatic at 6 months, quantitatively compare treatment experience, treatment engagement, self-reported clinical outcomes and recovery-oriented outcomes of patients randomized to continued-TER or PER.

Aim #3: To gain an in-depth understanding of patients' and providers' treatment experience, qualitatively compare those randomized to TCC, TER and PER.

Aim #4: To examine treatment heterogeneity among subgroups of patients randomized to TCC and TER based on race/ethnicity, age and clinical severity.