An evaluation of clinical decision support tools for Patient Health Questionnaire-9 administration

Area of Science:

• Health Informatics
• Clinical Decision Support Systems
• Mental Health Screening

Background:

• Healthcare institutions increasingly use the Patient Health Questionnaire 9 (PHQ-9) for depression screening and management.
• Clinical decision support (CDS) integrated into Electronic Health Records (EHRs) is a strategy to enhance PHQ-9 use, but effective design and implementation approaches are not well understood.

Purpose of the Study:

• To compare the implementation outcomes of two distinct CDS tool versions designed to improve PHQ-9 administration for patients with depression.

Main Methods:

• A retrospective, observational study compared two CDS versions: one that interrupted clinician workflow (Version 1) and one that did not (Version 2).
• Key outcomes assessed included reach, adoption, and effectiveness, with PHQ-9 administration determined via chart review.
• Chi-square tests analyzed the association between PHQ-9 administration and each CDS version.

Main Results:

• Version 1, the interruptive CDS, resulted in PHQ-9 administration in 15.3% of encounters (77/504).
• Version 2, the non-interruptive CDS, led to PHQ-9 administration in 9.8% of encounters (49/502).
• The difference in PHQ-9 administration rates between the two versions was statistically significant (P = .011).

Conclusions:

• Interruptive CDS tools appear more effective in increasing the administration of the PHQ-9.
• Non-interruptive CDS tools may be preferable for minimizing alert fatigue among clinicians, despite potentially lower effectiveness rates.