135-LB: Implementation of Depression Screening in a Pediatric Diabetes Clinic with Limited Mental Health Support

Abstract

Objective: Depression is common in adolescents with type 1 (T1D) and type 2 diabetes (T2D) , and for those with T1D, is associated with suboptimal health outcomes, including higher A1c levels and increased rates of hospitalizations. The ADA standards of care recommend integration of depression screening into routine medical care, but follow-up for positive screens is challenging in settings with limited mental health support. Here, we describe our latest PDSA cycle results from a quality improvement (QI) project for implementing depression screening in adolescents with diabetes. Methods: This QI project took place in a pediatric diabetes center without access to mental health support as part of routine diabetes care. Our goals were to 1) increase depression screening via the PHQ-9 from 0% to 80% over 2 years in all patients with T1D or T2D >11 yrs old and 2) refer 100% of patients who screened positive to behavioral health by the end of the 2-year period (Dec 2019-Dec 2021) . Our QI project included 4 Plan-Do-Study-Act (PDSA) cycles ranging from trialing PHQ-9 screening with a single provider (Cycle 1) to implementing screening across all providers (Cycle 4) . This abstract focuses on the last 6 months of PDSA Cycle 4 (previous cycles were presented at 2021 ADA Scientific Sessions) . Results: From July-Dec. 2021, a total of 68% of eligible patients completed PHQ-9 screening. Screening rates ranged from 46-90% across 5 different providers; 2 providers achieved screen rate goal of >80%. Of the 68%, 28% screened positive and 86% of them were referred to behavioral health. Referral rates for positive screens ranged from 83-100% per provider; 2 providers achieved refer rate goal of 100%. Conclusions: Although we did not achieve our PHQ-9 screen rate goal of 80% or our behavioral health refer rate goal of 100% by the end of 2 years, we found a major discrepancy in rates among providers. This prompted us to add an additional PDSA Cycle 5, which focuses on improving screening and refer rates for all providers. Disclosure S. Gurnurkar: None. A. Y. Kulasingham: None. J. Pierce: None.