Implementing Patient Health Questionnaire Depression Screening in Inflammatory Arthritis Clinic: Insights From a Quality Improvement Project at a Tertiary Rheumatology Center.

Abstract

This quality improvement project evaluates the feasibility and sustainability of adopting the Patient Health Questionnaire (PHQ) depression screening tool into routine clinical care at a rheumatology fellows' inflammatory arthritis (IA) clinic at a large tertiary center. The aim was to achieve 50% compliance in documentation of PHQ after five months. Providers received a 30-minute education on the importance of depression screening in patients with IA. A week after the education, two-step depression screening with the PHQ-2 followed by the PHQ-9 was implemented. Nurses performed PHQ-2 at each IA clinic visit verbally and documented the results while rooming patients using an electronic health record (EHR) dotphrase. Patients completed paper forms of the PHQ-9 only if the PHQ-2 score was positive for depression. Fellows then reviewed the PHQ-9 during the clinic visit and documented it using a separate EHR dotphrase. We tracked both PHQ-2 and PHQ-9 documentation rates as the key outcome measures. Before to the intervention, depression documentation rate was only 2%. After initial poor participation, nurses achieved the aim after repeated reminders and ongoing education by the senior nurse. Fellows failed to achieve the aim despite repeated reminders and education. Lack of time during clinic visit was found to be the biggest challenge. Sustained adoption of the PHQ was difficult to achieve. Additional support at the health systems level that prioritizes depression screening may need to take place. Additional research demonstrating improved IA outcomes in screened patients may also be helpful to gain more buy-in from providers.