P2.N268: Care Transformation: Universal Depression Screening in a Pediatric Multispecialty Practice

Purpose/Objectives: Mental health disorders are prevalent in pediatric populations. Patients with complex health issues requiring multispecialty care are at high risk. Care Transformation mandates from The Centers for Medicare and Medicaid Services underscore the need for universal depression screening during health care encounters. We developed a unique protocol and workflow to implement depression screening across 15 subspecialty practices.
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Aim: Increase depression screening for eligible 12-17-year-olds across subspecialty practices from zero to 25% within 12 months by implementing a process that connects patients to resources and ensures documentation.

Design/Methods: Extensive interdisciplinary planning involved system quality and mental health experts, physician leadership, nursing and staff management. A screening process using the Patient Health Questionnaire (PHQ)-9 was developed, and staff were trained. An algorithm was developed to manage patients who screened positive, based on severity. Resources were automatically included in after-visit summaries, including educational materials, community mental health resources (MHR), and emergency phone numbers (for all positive screens). Those screening moderately severe to severe were immediately connected to behavioral health consultation via a mental health hotline. A SmartPhrase (embedded block of text that autogenerates) was created to facilitate documentation. Screening was initially piloted in four specialties, and after modifications was implemented in the remaining 11 specialties. The Model for Improvement was utilized, testing changes via PDSA cycles. Measures included the percentage of patients screened (process); those who screened positive and had documentation of appropriate follow-up (outcome). Measures were tracked directly in the EHR.

Results: We reviewed 10,816 visits; 8,062 (1,466 baseline and 6,596 post-intervention) were eligible for depression screening. We increased screening rates from 0% to a median of 22.3% in the first month and ultimately to 33.8% at month five. In total, 2,179 (33.0%) patients were screened. Patients identifying as Asian were most likely (n=180, 37.9%) while patients who identified as another or >1 race were least likely to be screened (n=318, 30.7%), compared to patients identifying as white, Black, or Hispanic/Latino (p=0.03). There were no differences by gender or ethnicity. Adolescent medicine (n=23, 74%), general surgery (n=178, 55%), and endocrinology (n=835, 52%) had the highest screening rates, while cardiac surgery (n=0, 0%), and craniofacial clinic (n=0, 0%) had the lowest, p< 0.0001. Of patients with positive screens (454, 20.8%), scores varied from mild (n=288, 63.4%), moderate (n=107, 23.6%), moderately severe (n=45, 9.9%), and severe (n=14, 3.1%). Seventy-three (4.7%) patients had a positive suicide risk. Infectious disease (n=4, 7.7%) and allergy-immunology (n=16, 14.5%) had the lowest positive screen rates while developmental pediatrics, sleep medicine, and adolescent gynecology had the highest (>30%).

Conclusion/Discussion: We successfully implemented depression screening in 15 subspecialties and improved screening from zero to 33.8% in 6 months. Future directions include ensuring documentation of MHR connection and understanding specialty-specific nuances to allocate resources.