Improving Adolescent Depression Screening
ICSI and Stratis Health have combined practice facilitation resources to bring together a mix of primary and specialty care provider organizations for quality improvement activities as part of the MN State Innovation Model (SIM) cooperative agreement.
Sartell Pediatrics in Sartell, Minnesota, one partner in this project, has been working to improve its patients’ depression screening and documentation of PHQ2 and PHQ9 screening tool scores. Sartell Pediatrics is part of ICSI member Integrity Health Network, a regional health care network with over 200 primary care and specialty physicians.
The primary goal of this effort was for 80 percent of its 11–13-year-old wellness exam patients to have a completed and scored PHQ2 or PHQ9 documented in the electronic health record (EHR) and chart. Team members involved in the project include Jill Smith, practice manager (at left) and Kari Behling, nurse manager, along with front desk and business office staff and other clinical team members. It is worth noting that this effort began during both a major construction effort and migration to a new EHR!
The clinic made significant strides right away. In January, they hadn’t begun the focused screening, but by April they were screening 86 percent of targeted patients. Some highlights and lessons learned along the way include:
- They utilized receptionists to prepare for the wellness visits, placing a PHQ9 in the chart and scanning completed PHQ9 results back into the chart afterward.
- Changes were made to the clinic workflow to have the nurse administer a PHQ2 during patient intake. If any of the answers are positive (indicating depression), the nurse then asks all nine questions (PHQ9).
- They developed new processes to accommodate the different ways a patient’s PHQ9 information is received (via patient portal, printed forms, or nurse intake).
- An internal change was made to how the clinic bills for social/emotional screening, which has dramatically improved claim payments.
- They found ways to offer immediate assistance to patients with high PHQ9 scores (showing depressive symptoms), including development of a depression handout that includes the signs and symptoms of depression, talking about coping mechanisms, and sharing information about community resources.
- Crisis appointment slots were added to their psychologist’s schedule so patients in need can be seen more quickly.
Sartell Pediatrics continues to monitor depression screening progress across the board. “One of the great things about this practice facilitation work is how we learn to identify a goal, put a workflow in place, and then assess what the results are,” Smith said. “Based on these results, we can then review what we are doing and tweak accordingly. This allows us to continue to provide the best care and avoid breakdowns in the work structure.”
For more information about Sartell Pediatrics’ work, please contact Jill Smith.