Improving Primary Care Adolescent Depression Screening and Initial Management: A Quality Improvement Study.

Area of Science:

• Public Health
• Clinical Quality Improvement
• Adolescent Medicine

Background:

• Adolescent depression screening is recommended but challenging in primary care settings.
• Effective initial management following positive screens is crucial for adolescent mental health.
• Improving screening and management rates requires systematic quality improvement initiatives.

Purpose of the Study:

• To enhance adolescent depression screening rates during preventive care visits.
• To increase the documented initial management for adolescents with positive depression screens.
• To sustain these improvements over a 12-month period.

Main Methods:

• A quality improvement project was conducted across 12 urban primary care clinics.
• Interventions included standardized tablet-based screening with electronic health record (EHR) integration, provider education, and performance feedback.
• Target population included adolescents aged 12-17 years, predominantly Medicaid-enrolled.

Main Results:

• Standardized screening led to a high screening rate (91.9%).
• Initial implementation with tablets caused a temporary decrease in documented initial management (89.7% to 67.6%).
• Post-intervention adjustments, including EHR redesign and further education, improved documented initial management to 87.3%.

Conclusions:

• Tablet-based screening effectively boosts screening rates but necessitates further work for management optimization.
• A comprehensive systems approach, integrating EHR modifications, clinician education, and feedback, is vital for sustained improvements.
• Meaningful advancements in adolescent depression care require a multi-faceted strategy addressing both screening and subsequent management.