Operationalizing Depression Screening in Ambulatory Palliative Care: A Quality Improvement Project.
Daniel Shalev, Melissa Patterson, Yasemin Aytaman, Manuel A Moya-Tapia, Craig D Blinderman, Milagros D Silva, M Carrington Reid
Author Information
Daniel Shalev: Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine (D.S., M.D.S., M.C.R.), New York, New York, USA. Electronic address: Das2043@med.cornell.edu.
Melissa Patterson: Department of Medicine (M.P., M.A.M.T., C.D.B.), Columbia University Irving Medical Center, New York, New York, USA.
Yasemin Aytaman: Department of Medicine (Y.A.), Brooklyn Campus of the VA NY Harbor Healthcare System, Brooklyn, New York, USA.
Manuel A Moya-Tapia: Department of Medicine (M.P., M.A.M.T., C.D.B.), Columbia University Irving Medical Center, New York, New York, USA.
Craig D Blinderman: Department of Medicine (M.P., M.A.M.T., C.D.B.), Columbia University Irving Medical Center, New York, New York, USA.
Milagros D Silva: Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine (D.S., M.D.S., M.C.R.), New York, New York, USA.
M Carrington Reid: Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine (D.S., M.D.S., M.C.R.), New York, New York, USA.
BACKGROUND: Depression is common in the palliative care setting and impacts outcomes. Operationalized screening is unusual in palliative care. LOCAL PROBLEM: Lack of operationalized depression screening at two ambulatory palliative care sites. METHODS: A 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. INTERVENTION: The 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. RESULTS: Operationalized depression screening rates increased from 2% to 38%. All clinicians felt incorporation of depression screening was useful and feasible. CONCLUSIONS: Operationalized depression screening is feasible in ambulatory palliative care workflow, though optimization through having screening be completed prior to clinician visit might improve uptake.
