Abstract
Background: Depression affects up to 20% of patients with coronary artery disease (CAD), diabetes mellitus (DM), and congestive heart failure (CHF); and is associated with poorer health outcomes. HEDIS Depression Care Measure Set includes the utilization of PHQ-9 survey to monitor depression and appropriate treatment and follow-up. The goal of this program is to design, implement, and measure the success of a quality improvement (QI) initiative addressing HEDIS depression measures in the cardiovascular (CV) population. Methods: First an analysis of current practice and HEDIS compliance was conducted; 2. A plan was developed to address gaps in care; 3. A QI program was executed in the cardiac catheter lab; and 4. Outcome measures and methods to determine program success were designed. Results: Current practice analysis of the catheter lab revealed that depression screening, monitoring, and follow-up were not routinely conducted. Further, it was identified that the PHQ-9 screener was available in the EMR system but not being utilized. Therefore, a QI program was designed with the following components: 1. Patients > 18 years old receive the PHQ-9 upon discharge from the catheter lab; 2. If a patient scores > 10 on the PHQ-9 they receive education and are scheduled for follow-up; 3. A clinical database collects information on Framingham risk scores, CV risks, PHQ-9 scores, medical history, and biometric data. These data are then used to provide customized CV care plans including depression education; 4. A shared medical appointment (SMA) format provides additional depression education and follow-up. This program was executed in January 2014. The outcomes plan evaluates the impact of this QI program on HEDIS goal attainment and CV care. A control group receives screening, initial education, and standard of care. The intervention group receives screening, initial education, entry into the disease management database, customized education, therapeutic lifestyle counselling, and participation in the SMA focusing on depression. Currently 39 patients are enrolled in each arm. Interim analysis reveals 100% depression screening in both groups and high rates of follow-up in the intervention group (2 initial components of the HEDIS goals). Conclusions: Implementing a multi-faceted depression screening and follow-up QI program addresses HEDIS goals and has shown initial success in closing identified gaps in care. Future implications include a comparative analysis of the QI program to standard of care on composite HEDIS depression measures and CV goal attainment.
Published Version
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