改善儿科初级保健中的青少年抑郁筛查。
Improving Adolescent Depression Screening in Pediatric Primary Care.
机构信息
Departments of Pediatrics (VS Harder, SE Barry, S French, AB Consigli, and BL Frankowski); Psychiatry (VS Harder), Vermont Child Health Improvement Program, University of Vermont, Burlington.
Departments of Pediatrics (VS Harder, SE Barry, S French, AB Consigli, and BL Frankowski).
出版信息
Acad Pediatr. 2019 Nov-Dec;19(8):925-933. doi: 10.1016/j.acap.2019.02.014. Epub 2019 Mar 9.
OBJECTIVE
Depression among adolescents is a leading public health problem. Although screening for adolescent depression in primary care is strongly recommended, screening rates remain low. Effective quality improvement (QI) initiatives can facilitate change. This study aims to assess the impact of a QI learning collaborative on adolescent depression screening and initial plans of care in primary care.
METHODS
Seventeen pediatric-serving practices in Vermont participated in a QI learning collaborative aimed at improving practitioner knowledge and office systems around adolescent depression screening. Monthly medical record reviews provided monitoring of adolescent depression screening and initial plans of care over 7 months for QI. Randomly sampled annual medical record review data allowed comparison of screening and initial plans of care after the QI learning collaborative between participating and 21 control practices.
RESULTS
As practices improved their office systems around adolescent depression screening and initial plans of care, data showed marked improvement in depression screening at all 17 practices, from 34% to 97% over 7 months. Adolescents at participating practices had 3.5 times greater odds (95% confidence interval [CI], 1.14-10.98, P = .03) of being screened for depression and 37.5 times greater odds (95% CI, 7.67-183.48, P < .0005) of being screened with a validated tool than adolescents at control practices, accounting for patient characteristics.
CONCLUSIONS
There were significant within practice increases in adolescent depression screening after a QI learning collaborative, as well as in comparison with control practices 1 year later.
目的
青少年抑郁是一个主要的公共卫生问题。尽管强烈建议在初级保健中对青少年抑郁进行筛查，但筛查率仍然很低。有效的质量改进（QI）计划可以促进变革。本研究旨在评估 QI 学习合作对初级保健中青少年抑郁筛查和初始护理计划的影响。
方法
佛蒙特州的 17 家儿科服务实践参加了一项 QI 学习合作，旨在提高从业者在青少年抑郁筛查方面的知识和办公室系统。每月的医疗记录审查为 QI 提供了 7 个月的青少年抑郁筛查和初始护理计划的监测。随机抽样的年度医疗记录审查数据允许在 QI 学习合作后，将参与和 21 个对照实践的青少年抑郁筛查和初始护理计划进行比较。
结果
随着实践在青少年抑郁筛查和初始护理计划方面改进了其办公室系统，数据显示所有 17 家实践的抑郁筛查率显著提高，从 7 个月内的 34%提高到 97%。与对照实践相比，参与实践的青少年抑郁筛查的可能性高 3.5 倍（95%置信区间[CI]，1.14-10.98，P =.03），使用有效工具筛查的可能性高 37.5 倍（95%CI，7.67-183.48，P <.0005），这与患者特征有关。
结论
在 QI 学习合作后，以及与对照实践相比 1 年后，实践中青少年抑郁筛查的比例显著增加。
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