Operationalizing Depression Screening in Ambulatory Palliative Care: A Quality Improvement Project |
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| Affiliation: | 1. Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine (D.S., M.D.S., M.C.R.), New York, New York, USA;2. Department of Medicine (M.P., M.A.M.T., C.D.B.), Columbia University Irving Medical Center, New York, New York, USA;3. Department of Medicine (Y.A.), Brooklyn Campus of the VA NY Harbor Healthcare System, Brooklyn, New York, USA;1. Veteran Experience Center (D.K.,D.S.,A.K-L.), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA;2. Center for Health Equity Research and Promotion (J.T,), Pittsburgh VA Medical Center, Pittsburgh, Pennsylyania, USA;3. UNC Eshelman School of Pharmacy (J.T.), Chapel Hill, North Carolina, USA;4. Veterans Affairs Boston Healthcare System (M.W.), Boston, Massachusetts, USA;5. Division of General Internal Medicine and Primary Care, Department of Medicine (M.W.), Brigham and Women''s Hospital, Boston, Massachusetts, USA;6. Department of Psychosocial Oncology and Palliative Care (M.W.), Dana Farber Cancer Institute, Boston, Massachusetts, USA;7. University of Pennsylvania School of Nursing (A.K-L.), Philadelphia, Pennsylyania, USA;1. Brookdale Department of Geriatrics and Palliative Medicine (J.L.F., L.P.G., C.B.S.), Icahn School of Medicine at Mount Sinai, New York, New York, USA;2. Section of Palliative Care and Medical Ethics (R.M.A.), University of Pittsburgh, Pittsburgh, Pennsylvania, USAS;3. Geriatric Research (L.P.G.), Education & Clinical Center, James J. Peters Veterans’ Affairs Medical Center, Bronx, New York, USA;4. Division of Hematology and Medical Oncology (C.B.S.), Icahn School of Medicine at Mount Sinai, New York, New York, USA;1. VHA National Center for Ethics in Health Care (M.S.W., C.M.A.G.), Washington, District of Columbia, USA;2. Department of Pediatrics (M.S.W.), University of Nebraska Medical Center, Omaha, Nebraska, USA;3. Departments of Psychiatry and Internal Medicine (C.M.A.G.), Ethics Education, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA;1. Department of Integrated Traditional Chinese and Western Medicine (L.Z., N.L.), West China Hospital, Sichuan University, Chengdu, Sichuan, China;2. Sichuan Second Chinese Medicine Hospital (Y.L., D.X., Y.D.), Chengdu, Sichuan, China;3. Chengdu University of Traditional Chinese Medicine (X.X., Y.S.), Chengdu, Sichuan, China |
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| Abstract: | BackgroundDepression is common in the palliative care setting and impacts outcomes. Operationalized screening is unusual in palliative care.Local ProblemLack of operationalized depression screening at two ambulatory palliative care sites.MethodsA fellow-driven quality improvement initiative to implement operationalized depression screening using the patient health questionnaire-2 (PHQ-2). The primary measure was rate of EMR-documented depression screening. Secondary measures were clinician perspectives on the feasibility and acceptability of implementing the PHQ-2.InterventionThe intervention is a clinic-wide implementation of PHQ-2 screening supported by note templates, brief clinician training, referral resources for clinicians, and opportunities for indirect psychiatric consultation.ResultsOperationalized depression screening rates increased from 2% to 38%. All clinicians felt incorporation of depression screening was useful and feasible.ConclusionsOperationalized depression screening is feasible in ambulatory palliative care workflow, though optimization through having screening be completed prior to clinician visit might improve uptake. |
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