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Implementing clinic‐wide depression screening for pediatric diabetes: An initiative to improve healthcare processes
Author(s) -
Marker Arwen M.,
Patton Susana R.,
McDonough Ryan J.,
Feingold Heather,
Simon Lara,
Clements Mark A.
Publication year - 2019
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12886
Subject(s) - medicine , depression (economics) , glycemic , population , patient health questionnaire , family medicine , mental health , health care , quality of life (healthcare) , psychiatry , diabetes mellitus , depressive symptoms , nursing , anxiety , environmental health , economic growth , economics , macroeconomics , endocrinology
Objective Youth with type 1 diabetes (T1D) endorse high rates of depressive symptoms, which can significantly impair self‐management, glycemic control, and quality of life. Current guidelines recommend annual depression screening for all adolescents with T1D, but few models exist to implement screening procedures across clinics in this population. The primary aim of this project was to increase depression screening from 0% to 80% in four clinics, and to describe the structured quality improvement process to reach this goal. Methods All patients aged 12 to 21 years old with T1D at four participating clinics in a Midwestern hospital system were eligible to participate. Using a two‐stage process, patients were administered the Patient Health Questionnaire (PHQ‐2 plus PHQ‐9 if positive) annually. Rates of depression screening by clinic site, rates of positive depression screens, social worker documentation of follow‐up care, and associations with diabetes‐related health outcomes were analyzed. Results Over 2 years, average depression screening rates increased from 0% to 75% across all clinics, and 89% of patients with a positive screen met with a social worker for a targeted mental health assessment. At initial screening, 7.6% of patients screened positive for at‐risk depressive symptoms on the PHQ‐2 and from that group, 6.7% additionally screened positive on the PHQ‐9. Conclusions Annual depression screenings were feasibly implemented across four clinics and the use of real‐time data listening and automated processes facilitated successful implementation. Future directions include further automation, targeted training and billing mechanisms, dissemination to non‐metropolitan clinics, and further assessment of depression screening tools for adolescents with T1D.