PC2175: Improving Mental Health Screening in Pediatric Subspecialty Clinics

Purpose/Objectives: Mental health screening allows for early identification of patients at risk of mental health disorders such as anxiety and depression. Adolescents with chronic disease have higher rates of anxiety and depression. The Defense Health Administration Procedures Manual 6025.01 established that all patients greater than 12 years of age should receive annual mental health screening. To improve the rate of mental health screening in this at-risk population an A3 approach to quality improvement was undertaken in the Pediatric Subspecialty Clinic at Brooke Army Medical Center.

Design/Methods: Medical records from September 2020 to March 2021 of new patients seen in the pediatric cardiology and pulmonology clinics at Brooke Army Medical Center were reviewed for completion of mental health screens and scores of mental health screens. Following acquisition of baseline data, the A3 Lean Leader quality improvement approach was utilized to develop possible countermeasures. In October 2021 new patients presenting to the pediatric cardiology and pulmonology clinics 12 years and older began receiving GAD7 and PHQ9 screening questionnaires. These are validated mental health screens for patients 12 years and older. A standard operating procedure outlining scoring, reviewing, and referral recommendations was given to all providers in these clinics. A post-implementation chart review was conducted 8 weeks after implementation with the same variables. A second iteration was implemented with pediatric gastroenterology clinic added and is currently in progress.

Results: Baseline data showed 4 of 64 patients (6.3%) received any type of mental health screening. Of those conducted GAD7 had a 66.7% positivity rate and PHQ9 had a 25% positivity rate. Post intervention data for the first iteration showed 6 of 49 patients completed both the GAD7 and PHQ9 (12.2%) an increase of 193% from baseline. Positivity rate of 50% for both GAD7 and PHQ9 in post implementation data. For 3 weeks into the second iteration, 10 of 25 patients (40%) received mental health screening.

Conclusion/Discussion: Implementation of a mental health screening standard operating procedure increased the frequency of completion of GAD7 and PHQ9 screening in the pediatric pulmonary and cardiology clinics at Brooke Army Medical Center. High positivity rates were observed both baseline and post implementation for anxiety and depression. Providers noted that they reviewed questionnaires with patients but did not document findings as outlined in the standard operating procedures in the electronic medical record. Next steps for continued improvement will include completing second iteration data collection, implementing countermeasures, and expanding to remaining pediatric subspecialty clinics.