P2.O285: Improving the Management of Depression Within Primary Care Through a Team-based Approach Utilizing Quality Improvement Methodologies

Purpose/Objectives: To improve the management of adolescent patients (ages 12-17 years) with a positive depression screen through a team-based approach utilizing quality improvement (QI) methodology. The specific aims of this QI project were to increase the percentage of patients with a positive depression screen who had a follow-up appointment recommended from a baseline of 30% to 70 % and to decrease the average wait time for a follow-up behavioral health appointment from 35 days to 14 days and then to sustain these improvements for 12 months.

Design/Methods: We implemented this QI project over 12 months within the Nationwide Children’s Hospital Primary Care Network (PCN), consisting of 14 urban clinics with over 230,000 patient visits within the past year, and over 100,000 unique patients, the majority of whom are enrolled in Medicaid. The PCN has an interdisciplinary team including physicians, nurse practitioners, integrated psychologists, co-located therapists and care coordinators.
We leveraged our interdisciplinary team to provide comprehensive care for patients after a positive depression screen. A key intervention was developing workflows to streamline the screening process and enhance communication between team members regarding next steps (Figure 1). Integrated psychologists provided consultation and brief evidence-based treatments during medical appointments. Co-located therapists delivered a full course of evidence-based depression treatment within the primary care medical home. A care coordination team maintained a clinical registry to track and prioritize patients with higher depression screening scores for targeted outreach. Additional interventions utilized the electronic health record (EHR) to automatically score depression screens, alert providers to positive results, and provide clinical decision support for follow up. Data from the EHR continually updated the outreach clinical registry.
We utilized QI methodologies to develop a process map and monitored progress toward the project aims through statistical process control charts. The QI team annotated control charts with key interventions to illustrate temporal relationships between intentional process changes and improvements in the system.

Results: The percentage of patients with a follow-up recommendation after a positive depression screen increased from a baseline of 30% to a new process stage mean of 60% from January 2023- December 2023. During this same time, the average wait time for a behavioral health appointment decreased from 35.2 days to 19.1 days.

Conclusion/Discussion: A team-based approach to depression management informed by quality improvement methodology improved management of adolescent patients after a positive depression screen by increasing provider follow-up recommendations, improving access to behavioral health services and creating targeted outreach from a care coordination team. Developing a process map streamlined workflow and enhanced communication between team members. Next steps in this project include tracking follow up appointment completion.