Background Depression affects 12% to 20% of adolescents and up to 30% of Appalachian residents. Given its frequency, routine adolescent depression screening and management is recommended by the American Academy of Paediatrics. However, routine depression screening is limited. Quality improvement (QI) practice facilitators (PF) can help clinicians standardise care, remove unwanted variation and improve outcomes. A QI PF model may improve depression screening and management.
Objectives Increase use of a validated depression screening tool from 0% to 30%, and create a management plan for those diagnosed with depression from 43% to 85% by 6/30/2016 and sustain through 12/31/2016.
Methods QI PFs from Partners For Kids, an affiliate of Nationwide Children’s Hospital, supported a practice in Ohio’s Appalachia region to initiate a depression screening and management project with 6 months follow-up. PFs used the IHI Model for Improvement and led recurring, on-site meetings. Interventions included training from a NCH developmental and behavioural paediatrician, new workflows and implementing a change package — establishing referral sources, process to manage emergencies and effective management plan checklist. PFs performed regular audits of the project.
Results Screening for depression increased from 0% to 42% within 3 months with initial QI interventions and increased to 80% with subsequent interventions. Documentation of evidence-based management of depression increased from 43% to 85%. Depression diagnosis increased from 21 children in 2015 to 34 in 2016, a 62% increase.
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