Improving Depression Screening in Patients with IBD - A Quality Improvement Initiative

Introduction: Disparities in adherence to health maintenance recommendations have been well-documented in patients with IBD. Approaches to identify and address major depression in this population remain under-described. Methods: From August 2021 to June 2022, the team carried out a QI project leveraging the Institute for Healthcare Improvement’s Model for Improvement centering on mental health screening rates. The project team set a QI aim to increase the percentage of patients with a current PHQ-2 score (within the last 6 months) from 18% to 65% by June 30, 2022. Adherence to depression screening was quantified based on proportion of completed PHQ-2 questionnaires in all adult patients attending IBD clinic. Based on gap analysis findings, the project team implemented two interventions. The first (PDSA 1) was a multidisciplinary Tune-Up Clinic to address multiple health maintenance recommendations at one time in October and December 2021. The team implemented a Medical Assistant-driven standardized mental health screening process utilizing the PHQ-2 screening via the electronic health record in March 2022 (PDSA 2) and trained the team on its use. To support these patients who screened at 3 or above on the PHQ-2, the team worked to improve referral rates to the embedded GI psychologist through provider education and opportunity reminders. Additionally, the team set up monthly support groups in both English and Spanish to better care holistically for patients. Results: PDSA 1 did not improve PHQ-2 screening rates. PDSA 2 improved screening rates from 18% at baseline in August 2021 to 88% after three months of implementation (image 1). Since beginning, 62% of eligible patients were already followed by another mental health professional or received a referral to and made an appointment with the GI psychologist. Conclusion: Depression screening was identified as a gap in health maintenance in patients with IBD in an under-served population. The introduction of PHQ-2 administration to all patients in clinic led to a significant improvement in screening completion, and referrals to GI Psychologist. This model can be readily applied in IBD practice.Figure 1.: PHQ-2 Screening Rate by Month for Patients at IBD Clinic and Baseline Median Table 1. - Number of eligible patients and those receiving referrals to embedded GI psychologist Month Number of Patients with a Current PHQ-2 Score of 3 or Above Number of Patients with Score of 3 or Above Receiving Referral to GI Psychologist September 2021 1 1 October (Pre-PDSA 1) 2021 0 n/a October (Post-PDSA 1) 2021 1 1 November 2021 0 n/a December 2021 3 3 January 2022 0 n/a February 2022 2 1 March (Pre-PDSA 2) 2022 1 0 March (Post-PDSA 2) 2022 9 4 April 2022 2 2 May 2022 2 1 June 2022 1 0