| Description |
Universal screening of patients with the Patient Health Questionnaire (PHQ-9) depression screening tool can help identify those who may be at risk for suicide. This quality improvement (QI) project assesses the effectiveness of implementing and automating the PHQ-9 into an Electronic Medical Record (EMR) and workflow by applying process theory and leadership principles. A non-paired, post-implementation, mixed method, qualitative and quantitative survey, based on Normalization Process Theory by Dr. Carl May, was sent to 160 healthcare providers and staff with 84 respondents (N=84, 53%) to assess the effectiveness of implementing this new technological process into the EMR and workflow of providers and staff. Kruskal-Wallis H test and Chi-square statistical analyses were conducted to identify differences in perceptions among roles of providers, therapists, and staff. The Plan-Do-Study-Act (PDSA) Model for Improvement and leadership principles of shared vision, transparency, humility and teamwork were applied throughout the project. The PHQ-9 form was effectively implemented into the EMR and workflow. Providers and staff in seven outpatient behavioral health clinics were surveyed. Ninety-four percent of those surveyed strongly agreed or agreed that it is important to screen patients for depression and suicidality, and (81%) indicated they had sufficient training to fulfill their responsibilities. There was a perceived increase in workload due to automating the PHQ-9 by 63% of respondents. Differences in perceptions between prescribers, therapists, and staff were statistically significant on three questions including patient perceptions of the automated PHQ-9. The automated PHQ-9 was successfully implemented into more than 90 primary care, internal medicine and behavioral health clinics across a large not-for-profit integrated health system. Providers and staff strongly agree it is important to screen patients for depression and suicidality. The qualitative and quantitative findings were mostly consistent between prescribers, therapists and staff. Among these groups, there was a statistically IMPLEMENTING THE PHQ-9 3 significant difference in understanding of roles and responsibilities related to helping patients with the PHQ-9, patient perceptions, and perception of co-worker support of the automated PHQ-9. Implementing a new IT process can increase workload, during the early stages of implementation. Seeking and responding to feedback by identifying and correcting errors early during the pilot process, can lead to a successful large scale roll-out of a new technological process. |
