Improving Depression Screening in Primary Care: A Quality Improvement Initiative

Area of Science:

• Primary Care Medicine
• Public Health
• Quality Improvement Science

Background:

• The COVID-19 pandemic highlighted increased rates of depression, necessitating systematic mental health identification strategies.
• Primary care settings are underutilized for depression screening, with unclear methods for increasing screening rates.
• Effective strategies are needed to improve depression screening within family medicine practices.

Purpose of the Study:

• To describe a quality improvement initiative aimed at increasing depression screening rates in five Family Medicine clinics.
• To evaluate the effectiveness of a standardized workflow, health information technology integration, and educational interventions on depression screening.
• To identify factors influencing the likelihood of patients being up-to-date on depression screening.

Main Methods:

• A quality improvement initiative using four Plan-Do-Study-Act cycles was implemented.
• Interventions included a standardized screening workflow, electronic health record prompts, and provider/staff education.
• A multi-level logistic regression model analyzed 23,745 clinic encounters from September 2020 to April 2021.

Main Results:

• The proportion of patients up-to-date on depression screening increased from 61.03% to 82.33% over the study period.
• Older patients (65+) and those with comorbidities were more likely to be screened.
• Telemedicine visits were associated with lower odds of being up-to-date on screening.

Conclusions:

• The described quality improvement initiative provides a feasible and effective method for increasing depression screening in primary care.
• Systematic workflows and technological integration can enhance mental health screening in clinical practice.
• Lessons learned offer recommendations for designing future interventions to improve depression screening rates.