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927 Quality improvement practice facilitation to increase depression screening and behavioural health management in a paediatric practice in ohio’s appalachia
  1. Suzanne Hoholik,
  2. Christina Toth,
  3. Mike Fetzer,
  4. Rebecca Baum,
  5. Stephen Cardamone,
  6. Sean Gleeson
  1. Nationwide Children’s Hospital, US


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.

Conclusions Implementing behavioural health recommendations using PF led to increased screening, diagnosis and management of depression at an Appalachian primary care practice.

Abstract 927 Figure 1

Depression screening project

Abstract 927 Figure 2

Appropriate management plan for 11–18-year-olds identified with depression

Abstract 927 Figure 3

Depression screening tool used during WCC of 11–18 year olds

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