Improving recognition of depression in primary care: a study of evidence-based quality improvement.
BACKGROUND
Depression's high prevalence and large amount of potentially modifiable morbidity make it an excellent candidate for quality improvement (QI) techniques. Yet there is little evidence on how to promote adherence to evidence-based guidelines. A locally run research and QI project that was part of a larger National Institute of Mental Health-funded study to implement depression guidelines was implemented by a primary care team at a Department of Veterans Affairs (VA) ambulatory care center in 1997 and 1998. DEVELOPMENT OF THE QI INTERVENTION: The plan to improve screening and recognition entailed systematically screening all patients attending the primary care clinic; sending computer reminders to clerical staff, nursing assistants, and primary care providers; and auditing team performance with monthly feedback.


RESULTS
Once the intervention was in place, nearly all patients were screened. The primary care provider documented the assessment of whether a patient was depressed for nearly all patients who screened positive. Few resources were needed to maintain the project once it was implemented.


CONCLUSIONS
An evidence-based QI intervention led to profound and lasting changes in primary care providers' recognition of depression or depressive symptoms. The QI implementation continued for one year after the intervention's end, but a new VA computerized medical record system uses similar computer-generated reminders.
VA Center for the Study of Healthcare Provider Behavior, Sepulveda, California, USA. ssherman@ucla.edu
Scott E
SE
Sherman
Audree
A
Chapman
Daniel
D
Garcia
Joel T
JT
Braslow
D003625:Data Collection; D003863:Depression / Q000175:diagnosis*; D019317:Evidence-Based Medicine; D005500:Follow-Up Studies; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D015141:Los Angeles; D011320:Primary Health Care / Q000592:standards*; D017749:Total Quality Management / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs