title: Pre-post evaluation of automated reminders may improve detection and management of post-stroke depression.
abstract: BACKGROUND
  Post-stroke depression (PSD) occurs in at least one-third of stroke survivors, is associated with worse functional outcomes and increased mortality, and is frequently underdiagnosed and undertreated.
  
  
  OBJECTIVE
  To evaluate the effectiveness of an electronic medical record-based system intervention to improve the proportion of veterans screened and treated for PSD.
  
  
  METHODS
  Quasi-experimental study comparing PSD screening and treatment among veterans receiving post-stroke outpatient care one year prior to the intervention (the control group) to those receiving outpatient care during the intervention period (the intervention group); contemporaneous data from non-study sites included to assess temporal trends in depression diagnosis and treatment.
  
  
  METHODS
  Veterans hospitalized for ischemic stroke and/or receiving primary care (PC) or neurology outpatient follow-up within six months post-stroke at two (Veterans Affairs) VA Medical Centers.
  
  
  METHODS
  We formed clinical improvement teams at both sites. Teams developed PSD screening and treatment reminders and designed tailored implementation strategies for reminder use in PC and neurology clinics.
  
  
  METHODS
  Proportion screened for PSD within 6 months post-stroke; proportion screening positive for PSD who received an appropriate treatment action within 6 months post-stroke.
  
  
  RESULTS
  In unadjusted analyses, PSD screening was performed within 6 months for 85% of intervention (N = 278) vs. 50% of control (N = 374) patients (OR 6.2 , p < 0.001), and treatment action was received by 83% of intervention vs. 73% of control patients who screened positive (OR 1.8 p = 0.13). After adjusting for intervention, site and number of follow-up visits, intervention patients were more likely to be screened (OR 4.8, p < 0.001) and to receive a treatment action if screened positive (OR 2.45, p = 0.05). Analyses of temporal trends in non-study sites revealed no trend toward general increase in PSD detection or treatment.
  
  
  CONCLUSIONS
  Automated depression screening in primary and specialty care can improve detection and treatment of PSD.
authors.affiliation: Roudebush VAMC and VA Stroke QUERI, Indianapolis, IN, USA. Linda.Williams6@va.gov
authors.forename: Linda S
authors.initials: LS
authors.lastname: Williams
authors.forename: Susan
authors.initials: S
authors.lastname: Ofner
authors.forename: Zhangsheng
authors.initials: Z
authors.lastname: Yu
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Beyth
authors.forename: Laurie
authors.initials: L
authors.lastname: Plue
authors.forename: Teresa
authors.initials: T
authors.lastname: Damush
mesh_terms: D000368:Aged; D003863:Depression / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology*; D019468:Disease Management; D061345:Early Medical Intervention / Q000379:methods*; D057286:Electronic Health Records / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000523:psychology*; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology*