Improving the 1-Year Depression Remission Rate: A Plan-Do-Study-Act Quality Improvement Project

From the 2022 HVPA National Conference

Andrew Bodlak (Undergraduate, Creighton University), Jenny Xiao (Undergraduate), Cyle Johnson MD, Shannon Kinnan MD

Background

Major depressive disorder (MDD) is one of the most common psychiatric illnesses in the United States, with an estimated prevalence of 7.1% in US adults. The US Preventive Services Task Force recommends depression screening for all adults in the general population. The goal of MDD treatment is full remission, which is defined as patient health questionnaire-9 (PHQ-9) scores < 5.

The primary aim of this quality improvement project was to improve the rate of depression screening, and depression remission rate, at OneWorld federally qualified health center (FQHC) in Omaha, NE.

Objective

We aim to increase the rates of depression remission at OneWorld FQHC by increasing rates of evidence-based psychiatric care, through a multidisciplinary, plan-do-study-act quality improvement approach.

Methods

On 1/6/21, Information Technology (IT) updated the electronic health record (EHR) to auto-add depression to the problem list of patients with PHQ-9 > 9. They also generated two lists: patients with PHQ screenings due and patients who were not in remission. Starting on 6/1/21, therapists called patients with PHQ-9 scores due, performed PHQ-9 screenings, and encouraged those patients to seek treatment. The psychiatric team, including medical students and physicians, reviewed charts to provide treatment advice to primary care providers (PCPs) on patients who were not receiving evidence-based medical care (EBMC). On 4/25/22, a survey was sent to all PCPs to collect information regarding their confidence in treating psychiatric illness, their perceived usefulness of the psychiatric team’s consultations, and more.

% of patients in depression remission was calculated by # patients who achieved remission divided by # patients 12 years of age and older with a diagnosis of major depression or dysthymia with a PHQ-9 > 9 during a primary care visit from 11/1/18-present.

Results

As of 12/1/21, therapists contacted 315 patients and conducted 108 PHQ-9 screenings via telephone. 297 medical charts were reviewed by the psychiatric care team. They determined 82 patients were receiving appropriate EBMC. They also determined that 76 patients were not receiving EBMC and advised PCPs through a message on the EHR accordingly. The primary care clinic’s annual depression remission rates were 6.6% in 2018, 7.1% in 2019, and 11.87% in 2020. The most recent % of patients’ depression remission was recorded on 11/30/21 as 14.8%.

Conclusion

Improvements used a multidisciplinary approach incorporating the use of IT, therapists, psychiatric consultants, and PCPs. The project team will examine each of the interventions in more detail and communicate what has been most effective with improving depression remission.

Clinical Implication

This project contributed to an improved quality of healthcare. The clinic is on course to reach an annual depression remission rate much improved from previous years. Decreased rates of depression represent a decreased financial burden on patients, due to less healthcare resource use and increased work productivity. Decreased rates of depression also decreased risk to patient’s wellbeing from suicidality. We advocate for the employment of a support staff who can continue to review charts for evidence-based practice in treatment of depression. This interdisciplinary model could be adopted at any FQHC in the country.

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