Current Position Information
Family Practice Physician, KHEIR, S. Mark Taper Foundation Community Clinic, Los Angeles, California
Scholarly Research Project
Facilitating Depression Screening and Documentation
Ida Tuwatananurak, DO; Stephanie Richards, MD; Phillip Phelps, LCSW; Benjamin Skinker, MD
The UPMC Shadyside Family Health Center (FHC) has a long history of depression screening and diagnosis. Treatment progress is tracked using the PHQ-9 (a self-report depression symptom questionnaire). Historically, screening rates have been much higher than documentation of PHQ-9 scores. The aim of this project was to improve PHQ-9 documentation rates while maintaining screening rates.
An analysis was performed of depression screening rates and documentation of full PHQ8/9 during eligible adult patient visits during an eighteen-month interval. We compared rates with the baseline nurse-initiated, three-step process with A) a patient-driven automated electronic PHQ-8 entry process and B) a revised office flow incorporating ancillary staff (without automated entry). The outcome measures employed were screening rates and completed documentation rates of PHQ-8/9 for those with a positive screen.
At baseline, screening rates averaged 95% (n=11096/11658) with a PHQ completion rate of 31% (n=607/1921). Method (A), screening rates decreased to 67% (n=9466/14419) but PHQ-8 documentation improved to 91% (n=1697/1883). Method (B), averaged 73% screened (n=2052/2791) with 78% (n=109/139) PHQ9 documentation rate.
Changing office flow in any form can worsen outcomes thus, measuring the impact of change is critical. While a nurse-driven process shows strength in screening rates, automated entry shows strength in completed documentation rates. Incorporating staff without automated entry lies somewhere between the two. Automated electronic entry shows promise but requires some programming design changes. Before any change is made, getting input from the main users and stakeholders increases the likelihood of success.