Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-12-2018

Graduate Advisor

Laura Kuensting

Committee

Laura Kuensting, DNP, APRN, PCNS-BC, CPNP-PC, CPEN

Louise Miller, PhD, RN

Chris Elliott, MSW, LCSW

Abstract

Abstract

Problem: The Patient Centered Medical Home (PCMH) is a model of care that improves the quality and experience of care and decreases cost. Use of a validated depression screening tool for adult patients is a PCMH certification requirement. The purpose of this quality initiative was to obtain baseline data when a depression screening tool was utilized among adult patients in an internal medicine clinic within a Midwestern public health department.

Methods: This was a quality improvement project utilizing a descriptive and observational design. A retrospective medical record review was used to assess the rate of depression screening utilizing the PHQ-2 and PHQ-9, while also assessing use of treatment or referral when indicated.

Results: A total of 941 patients (N=941) were seen and 65% (n = 607) received a PHQ-2 screening. The rate of a PHQ-9 screening after scoring ³ 3 on the PHQ-2 was 44% (n = 42). The rate of patients treated with either medication, referral, or both was 80% (n = 93). Utilizing a Chi-Square analysis, results indicated a significant (p < .001) relationship between PHQ-2 and PHQ-9 screenings, as well as PHQ-9 and treatment.

Implications for Practice: Most patients screened with a positive PHQ-2 were likely to be screened positive with the PHQ-9. Likewise, those screened positive with the PHQ-9 were likely to have some treatment initiated. Patients were identified for depression who may not otherwise have been treated. Screening adult patients with the PHQ-2 and PHQ-9 depression screening tool contributed to the public health system achieving a requirement for PCMH recognition.

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