Quality improvement initiative significantly increases timely depression screening

Timely depression screening increased about 20% among patients after a quality improvement initiative was implemented at their primary care practices, according to findings published in the Journal of Community Health.

“Systematic depression screening was successfully incorporated into a primary care setting,” Sarah R. Blackstone, MPH, PhD, a research program adviser at the University of Virginia School of Medicine, and colleagues wrote. The initiative “worked to improve screening rates by adopting a universal screening tool, standardizing the screening process, automating EHR workflow, educating and engaging providers and clinical staff and developing objective criteria and processes for referral and regular data monitoring.”

Blackstone and colleagues implemented the quality improvement initiative at five family medicine clinics in Virginia. The initiative was based on the Plan, Do, Study, Act (PDSA) model. A new component of the initiative was introduced during four PDSA cycles, which included having rooming staff identify patients in need of depression screening according to a health maintenance section in their electronic health record, increasing education of depression screening among clinical staff and providers and automating email reminders to providers about depression screening and referrals.

The researchers analyzed the receipt or absence of depression screening for 23,745 clinic encounters with adult patients that occurred between September 2020 and April 2021. Of these encounters, 64% of patients were women and 68% were white.

Overall, 21% of patients had received a previous depression diagnosis and 20% had received a previous anxiety diagnosis, according to Blackstone and colleagues. At baseline, 50% to 80% of patients were up to date on depression screening, with an overall average of 61.03%. After the initiative was implemented, 63% to 88% of patients were up to date on screening, with an average of 82.33%, the researchers reported.

Patients aged 65 to 84 years (adjusted OR = 1.44; 95% CI, 1.32-1.57) and patients aged 85 years and older (aOR = 1.23; 95% CI, 1-1.51) were more likely to be up to date on screening compared with patients aged 18 to 44 years. Those with comorbidities were also more likely to be up to date on screening, according to Blackstone and colleagues. However, they found that patients with telehealth appointments had lower odds of receiving timely depression screening (aOR = 0.51; 95% CI, 0.46-0.56).

The findings indicate that the quality improvement initiative was associated with a “significant improvement in depression screening” over the study period, according to the researchers. However, “there is a need for developing innovative ways to complete population health management screenings without increasing the documentation burden on clinic staff,” Blackstone and colleagues wrote.