Improving Primary Care Adolescent Depression Screening and Initial Management: A Quality Improvement Study

Abstract

Introduction: Although recommended, adolescent depression screening with appropriate initial management is challenging. This project aimed to improve adolescent depression screening rates during preventive care visits in 12 primary care clinics from 65.4% to 80%, increase the proportion of documented initial management for those with a positive screen from 69.5% to 85%, then sustain improvements for 12 months. Methods: This quality improvement project involved 12 urban primary care clinics serving >120,000 mostly Medicaid-enrolled patients and targeted adolescents 12-17 years. Interventions included standardized depression screening using tablets with electronic health record (EHR) capture and automated scoring, embedding screening results and initial management actions into the EHR, provider education, and individual clinician and clinic performance feedback. Results: After standardizing the approach to screening, the process mean depression screening rate was 91.9%. However, after adopting tablets into the clinic flow, there was an unexpected initial decrease in proportion with appropriately documented initial management plans, from 89.7% to 67.6%. In response to this special cause variation, there was additional provider feedback and education, and a redesign of the EHR flow related to the presentation of results and prompts for action after a positive screen. As a result, the proportion with appropriately documented initial management was 87.3% by project completion. Conclusions: Tablet-based screening with EHR scoring capture effectively increased depression screening rates but required significant additional work to improve initial management after a positive screen. A full system approach, including EHR modification, clinician education, and performance feedback, is needed to make meaningful, sustained improvements in comprehensive adolescent depression screening.

Improving Postpartum Depression Screening in the NICU: Partnering with Students to Improve Outreach

“…We may also be able to utilize the platform to help improve our screening percentage, as other screening programs have demonstrated. 28 Another limitation is that the sustainability of the current process relies on having interested students join the team. As a large academic institution, we have been able to recruit students to join our team easily; however, even if this were not possible, our results support the need for personnel focused on universal PPD screening in the NICU.…”

“…We may also be able to utilize the platform to help improve our screening percentage, as other screening programs have demonstrated. 28 …”

Pediatric mental health crisis: Propelling the Surgeon General’s advice to action.

“…The Surgeon General report highlights the important role that routine screening for youth mental health challenges plays within and beyond health care settings, particularly when that screening is linked to appropriate and equitable treatment. A multitude of studies show that we can effectively implement mental health and developmental screening in primary care (e.g., Beck et al, 2022; Lipkin et al, 2020; Sokol et al, 2019); for a list of pediatric screeners appropriate for primary care, refer to the Screening Technical Assistance and Resource Center (American Academy of Pediatrics, 2022).…”