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Accelerated Recovery from Posttraumatic Stress Disorder in a Structured Outpatient Specialty Care Model: A Matched Cohort Study

Khor, S.; Klempner, H.; Dworkin, E. R.; Schwehm, A.; Brown, M.; Chekroud, A.; Hawrilenko, M.

2026-03-02 health systems and quality improvement
10.64898/2026.02.27.26347276 medRxiv
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ObjectiveAlthough trauma-focused psychotherapies are effective for posttraumatic stress disorder (PTSD), recovery under routine outpatient conditions remains variable. We examined whether participation in a structured Specialty Care (SC) model integrating clinician specialization, flexible treatment density, and coordinated navigation was associated with accelerated PTSD recovery compared with standard outpatient care. MethodsWe conducted a retrospective matched cohort study (2024-2025) of U.S. adults with active PTSD symptoms (PTSD Checklist for DSM-5 score [&ge;]31) receiving care through an employer-sponsored digital mental health platform. Access to SC was determined by employer benefit design. Propensity-score matching with weighting balanced cohorts on baseline severity and demographics. Primary outcomes included longitudinal PTSD symptom trajectories and time to recovery, remission, and reliable improvement. Secondary outcomes assessed depressive symptoms (PHQ-9). Linear mixed-effects and Cox proportional hazards models were applied. ResultsThe matched sample included 356 SC and 9,409 standard care participants. SC participants received higher treatment intensity, including greater session volume and faster early follow-up, and greater care navigation engagement. SC participation was associated with steeper PTSD symptom decline ({beta} = -1.3 per log-week, p < .001) and a higher likelihood of recovery (hazard ratio = 1.31; 95% CI, 1.10-1.57). At 12 weeks, predicted recovery was 29% in SC versus 23% in standard care. Depressive symptoms improved in both groups, without significant differences in time to categorical recovery. ConclusionsUnder routine outpatient conditions, a structured SC model was associated with accelerated PTSD recovery, suggesting that reorganization of outpatient delivery may improve real-world outcomes.

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