TY - JOUR
T1 - Increasing Recognition and Diagnosis of Adolescent Depression
T2 - Project RedDE: A Cluster Randomized Trial
AU - Rinke, Michael L.
AU - Bundy, David G.
AU - Stein, Ruth E.K.
AU - O'Donnell, Heather C.
AU - Heo, Moonseong
AU - Sangvai, Shilpa
AU - Lilienfeld, Harris
AU - Singh, Hardeep
N1 - Publisher Copyright:
© 2019 the Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2019/9/30
Y1 - 2019/9/30
N2 - Background: Adolescent depression causes appreciable morbidity and is underdiagnosed in primary care. This study investigated whether a quality improvement collaborative (QIC) increases the frequency of adolescent depression diagnoses, thus reducing missed diagnoses. Methods: During a cluster-randomized clinical trial, a national cohort of primary care pediatric practices worked in different orders based on randomization to improve performance on each of three different diagnoses; one was increasing adolescent depression diagnoses. While improving their first diagnosis during an 8-month action period, practices collected control data for a different diagnosis. In two subsequent 8-month periods, practices worked to improve two additional diagnoses and continued to provide data on the ability to sustain and maintain improvements. The QIC intervention included day-long video conferences, transparent data sharing, analysis of failures, QI coaching, and tools to help improve diagnostic performance, including the Patient Health Questionnaire-9 Modified. The primary outcome was the measured frequency of depression diagnoses in adolescent health supervision visits compared via generalized mixed-effects regression models. Results: Forty-three practices were randomized with 31 in the final analysis. We included 3,394 patient visits in the control and 4,114 in the intervention phases. The adjusted percentage of patients with depression diagnoses increased from 6.6% in the control to 10.5% in intervention phase (Risk Difference (RD) 3.9%; 95% CI 2.4%, 5.3%). Practices sustained these increases while working on different diagnoses during the second (RD -0.4%; 95% CI -2.3, 1.4%), and third action periods (RD -0.1%; 95% CI -2.7%, 2.4%). Conclusions: A QIC intervention can sustainably increase adolescent depression diagnoses.
AB - Background: Adolescent depression causes appreciable morbidity and is underdiagnosed in primary care. This study investigated whether a quality improvement collaborative (QIC) increases the frequency of adolescent depression diagnoses, thus reducing missed diagnoses. Methods: During a cluster-randomized clinical trial, a national cohort of primary care pediatric practices worked in different orders based on randomization to improve performance on each of three different diagnoses; one was increasing adolescent depression diagnoses. While improving their first diagnosis during an 8-month action period, practices collected control data for a different diagnosis. In two subsequent 8-month periods, practices worked to improve two additional diagnoses and continued to provide data on the ability to sustain and maintain improvements. The QIC intervention included day-long video conferences, transparent data sharing, analysis of failures, QI coaching, and tools to help improve diagnostic performance, including the Patient Health Questionnaire-9 Modified. The primary outcome was the measured frequency of depression diagnoses in adolescent health supervision visits compared via generalized mixed-effects regression models. Results: Forty-three practices were randomized with 31 in the final analysis. We included 3,394 patient visits in the control and 4,114 in the intervention phases. The adjusted percentage of patients with depression diagnoses increased from 6.6% in the control to 10.5% in intervention phase (Risk Difference (RD) 3.9%; 95% CI 2.4%, 5.3%). Practices sustained these increases while working on different diagnoses during the second (RD -0.4%; 95% CI -2.3, 1.4%), and third action periods (RD -0.1%; 95% CI -2.7%, 2.4%). Conclusions: A QIC intervention can sustainably increase adolescent depression diagnoses.
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U2 - 10.1097/pq9.0000000000000217
DO - 10.1097/pq9.0000000000000217
M3 - Article
AN - SCOPUS:85126185095
SN - 2472-0054
VL - 4
JO - Pediatric Quality and Safety
JF - Pediatric Quality and Safety
IS - 5
M1 - e217
ER -