Smells like Teen Spirit: Increasing Adolescent Depression Screening Rates at the Family Health Center
Rebecca Wadlinger, DO, MS, ATC; Phil Phelps, LCSW, BCD; Stephanie Richards, MD; Lindsay Nakaishi, MD, MPH
Background:
Prior to this project, our clinic screened 15-18 years old patients for depression. We hypothesized that if we expanded our age range to 11-18 years old (to follow new national recommendations) and increased our screening rates we would diagnose more adolescents with depression and could appropriately address depression using standard management algorithms.
Methods:
PDSA cycle 1: Physician education on depression screening and medical management, creation of standard screening workflows and management algorithms, and chart review to monitor screening and algorithm utilization rates. PDSA cycle 2: Adjusted workflow based on prior chart review targeting appropriate screening documentation, expanded physician education of protocols and conducted second chart review.
Results:
Prior to project initiation, only 29% (n = 100) of our target population was screened. During the first month of the project, 50% of adolescents were screened in October 2018 (n=32); at the end of the second PDSA, 93% were screened in January 2019 (n=16) Our final positive depression diagnosis rate from November 2018-January 2019 was 35% (n=49). Throughout the project, there was a linear increase in the utilization of the management algorithm from 0% in October 2018 to 100% utilization in January 2019.
Conclusion:
Depression screening is now standard for 11-17 years old visits, resulting in increased screening rates. Our adolescent depression rate of 35% is higher than the national average; thus, it is imperative our clinic has standard depression screening and management systems. The 100% management algorithm utilization rate demonstrates our physicians’ ability to appropriately address adolescent depression.