Not Missing the Opportunity: Improving Depression Screening and Follow-Up in a Multicultural Community  Ann M. Schaeffer, DNP, CNM, Diana Jolles, PhD, CNM  Joint Commission Journal on Quality and Patient Safety  Volume 45, Issue 1, Pages 31-39 (January 2019) DOI: 10.1016/j.jcjq.2018.06.002 Copyright © 2018 The Joint Commission Terms and Conditions

Figure 1 Baseline percentage of screen-positive patients prior to the project was 12.5% without a standardized tool being used universally. Written PHQs in English, Spanish, Russian, Arabic, Tigrinya, Swahili, and Kurdish were administered over four PDSA cycles, with provision of screening cues to the team. Only 5% of clients were unable to complete a written PHQ; those were given verbally. Identified PHQ positive (>0) with new processes was 45.5% of all clients seen during the study time period. Loss of care coordinator resulted in a special cause variation in the data late in PDSA cycle 2. PHQ, Patient Health Questionnaire; PDSA, Plan-Do-Study-Act. Joint Commission Journal on Quality and Patient Safety 2019 45, 31-39DOI: (10.1016/j.jcjq.2018.06.002) Copyright © 2018 The Joint Commission Terms and Conditions

Figure 2 Follow-up included completed phone calls, kept appointments with behavioral health or the provider, and warm handoffs. The last three data points were post-project, and therefore represent long-term follow-up. While compliance declined from the peak, the median remained above the baseline four weeks after the project's conclusion. Data suggest that patient engagement with compliance is higher with shorter, evidence-based intervals for follow-up. PDSA, Plan-Do-Study-Act. Joint Commission Journal on Quality and Patient Safety 2019 45, 31-39DOI: (10.1016/j.jcjq.2018.06.002) Copyright © 2018 The Joint Commission Terms and Conditions

Figure 3 Composite measure: To meet the project aim, a client was appropriately screened as positive on the PHQ, engaged with shared decision making using the Option Grid, and choice of care plan, and evidence-based plan of care was correctly documented in the EHR. Inconsistent documentation of Option Grid use and patient's choice of care plan in the EHR led to introduction of the +PHQ template in the second PDSA cycle. Increasing and sustaining team engagement in PDSA cycles 2–4 resulted in higher rates of screening. Team engagement was reinforced with a variety of strategies, including addition of team huddles and sharing de-identified client stories. As a result, by PDSA cycle 4, team members were consistently taking the initiative to screen clients on their own. PHQ, Patient Health Questionnaire; EHR, electronic health record; PDSA, Plan-Do-Study-Act. Joint Commission Journal on Quality and Patient Safety 2019 45, 31-39DOI: (10.1016/j.jcjq.2018.06.002) Copyright © 2018 The Joint Commission Terms and Conditions