TY - JOUR
KW - Depression
KW - primary care
KW - Quality Improvement
AU - E. R. Pfoh
AU - I. Janmey
AU - A. Anand
AU - K. A. Martinez
AU - I. Katzan
AU - M. B. Rothberg
A1 - 
AB - BACKGROUND: Unless implementation of systematic depression screening is associated with timely treatment, quality measures based on screening are unlikely to improve outcomes. OBJECTIVE: To assess the impact of integrating systematic depression screening with clinical decision support on depression identification and treatment. DESIGN: Retrospective pre-post study. PARTICIPANTS: Adults with a primary care visit within a large integrated health system in 2016 were included. Adults diagnosed with depression in 2015 or prior to their initial primary care visit in 2016 were excluded. INTERVENTION: Initiation of systematic screening using the Patient Health Questionnaire (PHQ) which began in mid-2016. MAIN MEASURES: Depression diagnosis was based on ICD codes. Treatment was defined as (1) antidepressant prescription, (2) referral, or (3) evaluation by a behavioral health specialist. We used an adjusted linear regression model to identify whether the percentage of visits with a depression diagnosis was different before versus after implementation of systematic screening. An adjusted multilevel regression model was used to evaluate the association between screening and odds of treatment. KEY RESULTS: Our study population included 259,411 patients. After implementation, 59% of patients underwent screening. Three percent scored as having moderate to severe depression. The rate of depression diagnosis increased by 1.2% immediately after systematic screening (from 1.7 to 2.9%). The percent of patients with diagnosed depression who received treatment within 90 days increased from 64% before to 69% after implementation (p < 0.01) and the adjusted odds of treatment increased by 20% after implementation (AOR 1.20, 95% CI 1.12-1.28, p < 0.01). CONCLUSIONS: Implementing systematic depression screening within a large health care system led to high rates of screening and increased rates of depression diagnosis and treatment.
AD - Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA. Pfohe@ccf.org.; Case Western Reserve University School of Medicine, Cleveland, OH, USA.; Center for Behavioral Health, Cleveland Clinic, Cleveland, OH, USA.; Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA.; Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.; Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA.
BT - Journal of general internal medicine
C5 - Healthcare Disparities; Measures
CP - 11
DO - 10.1007/s11606-020-05856-5
IS - 11
JF - Journal of general internal medicine
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Unless implementation of systematic depression screening is associated with timely treatment, quality measures based on screening are unlikely to improve outcomes. OBJECTIVE: To assess the impact of integrating systematic depression screening with clinical decision support on depression identification and treatment. DESIGN: Retrospective pre-post study. PARTICIPANTS: Adults with a primary care visit within a large integrated health system in 2016 were included. Adults diagnosed with depression in 2015 or prior to their initial primary care visit in 2016 were excluded. INTERVENTION: Initiation of systematic screening using the Patient Health Questionnaire (PHQ) which began in mid-2016. MAIN MEASURES: Depression diagnosis was based on ICD codes. Treatment was defined as (1) antidepressant prescription, (2) referral, or (3) evaluation by a behavioral health specialist. We used an adjusted linear regression model to identify whether the percentage of visits with a depression diagnosis was different before versus after implementation of systematic screening. An adjusted multilevel regression model was used to evaluate the association between screening and odds of treatment. KEY RESULTS: Our study population included 259,411 patients. After implementation, 59% of patients underwent screening. Three percent scored as having moderate to severe depression. The rate of depression diagnosis increased by 1.2% immediately after systematic screening (from 1.7 to 2.9%). The percent of patients with diagnosed depression who received treatment within 90 days increased from 64% before to 69% after implementation (p < 0.01) and the adjusted odds of treatment increased by 20% after implementation (AOR 1.20, 95% CI 1.12-1.28, p < 0.01). CONCLUSIONS: Implementing systematic depression screening within a large health care system led to high rates of screening and increased rates of depression diagnosis and treatment.
PY - 2020
SN - 1525-1497; 0884-8734; 0884-8734
SP - 3141
EP - 3147
EP - 
T1 - The Impact of Systematic Depression Screening in Primary Care on Depression Identification and Treatment in a Large Health Care System: A Cohort Study
T2 - Journal of general internal medicine
TI - The Impact of Systematic Depression Screening in Primary Care on Depression Identification and Treatment in a Large Health Care System: A Cohort Study
U1 - Healthcare Disparities; Measures
U2 - 32495093
U3 - 10.1007/s11606-020-05856-5
VL - 35
VO - 1525-1497; 0884-8734; 0884-8734
Y1 - 2020
Y2 - Nov
ER -