TY - JOUR
AU - C. Murphy
AU - S. E. Molisani
AU - A. C. Riisen
AU - C. M. Scotti-Degnan
AU - D. Karvounides
AU - S. Witzman
AU - M. C. Kaufman
AU - A. K. Gonzalez
AU - M. Ramos
AU - C. L. Szperka
AU - N. S. Abend
A1 - 
AB - BACKGROUND AND OBJECTIVES: We conducted a quality improvement initiative to implement standardized screening for anxiety among adolescents with headache and/or epilepsy receiving outpatient neurology care at a quaternary health care system, consistent with recommendations from the American Academy of Neurology. Our SMART (Specific, Measurable, Achievable, Relevant, and Time-Based) aim was to screen ≥90% of established patients aged 12 years or older seen by a participating health care professional using a standardized anxiety screener by February 2024. METHODS: This initiative was conducted in patients seen for follow-up by 17 participating neurology health care professionals. Health care professional opinions were assessed before and after implementation of the Generalized Anxiety Disorder-7 (GAD-7), administered as a previsit questionnaire distributed using the electronic health record. The integrated workflow included a best practice advisory (BPA) alert that permitted easy access to interventions and automatic population of education materials into the after-visit summary. After 12 months of use (March 2023 to February 2024), we assessed demographic and diagnostic information, GAD-7 completion rates, anxiety symptom severity, BPA utilization, and health care professional acceptance of the intervention. RESULTS: The GAD-7 was completed for 64% of 3,671 encounters and by 71% of 2031 unique patients. The GAD-7 was more often completed for encounters if the patient was female, younger, or White or had a headache diagnosis. Among unique patients, anxiety symptoms were minimal in 50%, mild in 24%, moderate in 17%, and severe in 10%. Severe anxiety symptoms were more often present in female patients or those with a headache diagnosis. Among patients with severe anxiety symptoms, 66% had established behavioral health care plans and, for remaining patients, referrals were made to community behavioral health care professionals (11%), or pediatric psychologists (4%) or social workers (3%) within neurology. Clinicians indicated that the approach was easy to use and improved the quality of patient care. DISCUSSION: We implemented standardized EHR-based screening for anxiety symptoms for pediatric neurology patients, most of whom had headache or epilepsy. Screening was feasible, and approximately one-quarter of patients had moderate or severe anxiety symptoms. Future work will focus on improving completion rates of previsit questionnaires including the GAD-7 and optimizing clinician actions based on the screening data.
AD - Section of Pediatric Psychology, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia.; Division of Pediatric Neurology, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and the University of Pennsylvania.; Department of Digital and Technology Services, Children's Hospital of Philadelphia; and.; Department of Biomedical and Health Informatics, Translational Informatics Group, Children's Hospital of Philadelphia, PA.
AN - 40182316
BT - Neurol Clin Pract
C5 - Healthcare Disparities; Medically Unexplained Symptoms
CP - 3
DA - Jun
DO - 10.1212/cpj.0000000000200458
DP - NLM
ET - 20250328
IS - 3
JF - Neurol Clin Pract
LA - eng
N2 - BACKGROUND AND OBJECTIVES: We conducted a quality improvement initiative to implement standardized screening for anxiety among adolescents with headache and/or epilepsy receiving outpatient neurology care at a quaternary health care system, consistent with recommendations from the American Academy of Neurology. Our SMART (Specific, Measurable, Achievable, Relevant, and Time-Based) aim was to screen ≥90% of established patients aged 12 years or older seen by a participating health care professional using a standardized anxiety screener by February 2024. METHODS: This initiative was conducted in patients seen for follow-up by 17 participating neurology health care professionals. Health care professional opinions were assessed before and after implementation of the Generalized Anxiety Disorder-7 (GAD-7), administered as a previsit questionnaire distributed using the electronic health record. The integrated workflow included a best practice advisory (BPA) alert that permitted easy access to interventions and automatic population of education materials into the after-visit summary. After 12 months of use (March 2023 to February 2024), we assessed demographic and diagnostic information, GAD-7 completion rates, anxiety symptom severity, BPA utilization, and health care professional acceptance of the intervention. RESULTS: The GAD-7 was completed for 64% of 3,671 encounters and by 71% of 2031 unique patients. The GAD-7 was more often completed for encounters if the patient was female, younger, or White or had a headache diagnosis. Among unique patients, anxiety symptoms were minimal in 50%, mild in 24%, moderate in 17%, and severe in 10%. Severe anxiety symptoms were more often present in female patients or those with a headache diagnosis. Among patients with severe anxiety symptoms, 66% had established behavioral health care plans and, for remaining patients, referrals were made to community behavioral health care professionals (11%), or pediatric psychologists (4%) or social workers (3%) within neurology. Clinicians indicated that the approach was easy to use and improved the quality of patient care. DISCUSSION: We implemented standardized EHR-based screening for anxiety symptoms for pediatric neurology patients, most of whom had headache or epilepsy. Screening was feasible, and approximately one-quarter of patients had moderate or severe anxiety symptoms. Future work will focus on improving completion rates of previsit questionnaires including the GAD-7 and optimizing clinician actions based on the screening data.
PY - 2025
SN - 2163-0402 (Print); 2163-0402
SP - e200458
ST - Quality Improvement Initiative to Implement Anxiety Screening for Children and Teens With Headache and Epilepsy
T1 - Quality Improvement Initiative to Implement Anxiety Screening for Children and Teens With Headache and Epilepsy
T2 - Neurol Clin Pract
TI - Quality Improvement Initiative to Implement Anxiety Screening for Children and Teens With Headache and Epilepsy
U1 - Healthcare Disparities; Medically Unexplained Symptoms
U3 - 10.1212/cpj.0000000000200458
VL - 15
VO - 2163-0402 (Print); 2163-0402
Y1 - 2025
ER -