832-P: Implementation of Depression Screening in a Pediatric Diabetes Clinic with Limited Mental Health Services

Objective: Depression is up to 3 times more common in adolescents with diabetes than in their healthy peers and is associated with higher A1c values, and increased rates of diabetes-related hospitalizations. The ADA standards of care recommend integration of psychosocial screening into comprehensive medical care, but this is challenging in settings with limited mental health services. Here, we describe our quality improvement (QI) process for implementing depression screening in a pediatric diabetes center with limited mental health services.

Methods: This QI project took place in a pediatric children’s hospital that includes 3 satellite clinics. Routine diabetes care does not include integrated social work or psychology providers. Our goal is to increase PHQ-9 screening from 0% to 80% over 2 years in patients with diabetes (T1 or T2D) >11 yrs old across all 4 sites and to provide appropriate follow-up services for 100% of positive screens. We began our QI project in Dec. 2019 and present data through Oct. 2020. This includes 4 Plan-Do-Study-Act (PDSA) cycles ranging from trialing PHQ-9 screening with a single provider (Cycle 1) to implementing PHQ-9 screening across all providers and sites utilizing more efficient EMR processes (Cycle 4).

Results: Cycle 1 demonstrated a baseline screening average of 35.7%, of which 11.4% had a positive PHQ-9 screen. Screening rates improved by the end of Cycle 4 to 46-88% across the 4 sites. 100% of patients with positive screens were referred to Behavioral Health for further evaluation and treatment. Of note, screening rates decreased in April/May 2020 (Cycle 2), due to COVID and subsequent clinic closure.

Conclusions: Our QI methodology was effective in implementing depression screening in adolescent patients with rates of screening increasing over time and at all of our sites as more efficient methods were utilized. Continued efforts to screen and follow-up will focus on addressing barriers to evaluating and obtaining treatment for depression.