Department of Pediatrics, Divisions of a Rheumatology, Nationwide Children's Hospital and The Ohio State University, Ohio, Columbus, USA.
Department of Pediatrics, Division of Rheumatology, Nemours/A.I. duPont Hospital for Children, and Thomas Jefferson University, Delaware, Wilmington, USA.
Pediatr Rheumatol Online J. 2021 Aug 3;19(1):116. doi: 10.1186/s12969-021-00576-4.
Despite being at high risk for depression, patients with childhood-onset systemic lupus erythematosus (c-SLE) are infrequently and inconsistently screened for depression by their pediatric rheumatologists. We aimed to systematically increase rates of formal depression screening for c-SLE patients in an academic Pediatric Rheumatology clinic.
Our multi-disciplinary quality improvement (QI) team used electronic health record (EHR) documentation to retroactively calculate baseline rates of documented depression screening using the Patient Health Questionnaire-9 (PHQ-9). We then engaged key stakeholders to develop a clinical workflow for formal depression screening in the clinic. We also provided education to providers regarding mental health disorders in c-SLE, with an emphasis on prevalence, screening methods, and management of positive screens. We then used the Plan-Do-Study Act (PDSA) method of QI to systematically evaluate and adjust our process in real time. The primary outcome was the percentage of patients with c-SLE seen per month who had a documented PHQ-9 screening within the past year.
The percentage of children with documented PHQ-9 results ranged from 0 to 4.5 % at baseline to 91.0 % within 12 months of project initiation. By the end of the project, monthly screening rates greater than 80 % has been sustained for 10 months. As a result of these efforts, twenty-seven (48.2 %) patients with at least mild depressive symptoms were identified while seven (12.5 %) with thoughts of self-harm were referred to appropriate mental health resources.
Routine formal depression screening is feasible in a busy subspecialty clinic. Using QI methods, rates of formal depression screening among children with c-SLE were increased from an average of 3.3 % per month to a sustained monthly rate of greater than 80 %. Individuals with depressive symptoms and/or thoughts of self-harm were identified and referred to appropriate mental health resources.
尽管患有儿童期起病的系统性红斑狼疮（c-SLE）的患者有较高的抑郁风险，但儿科风湿病医生对他们进行抑郁症筛查的频率较低且不一致。我们旨在通过一个学术性儿科风湿病门诊系统地提高对 c-SLE 患者进行正式抑郁症筛查的比例。
我们的多学科质量改进（QI）团队使用电子健康记录（EHR）文档，通过患者健康问卷-9（PHQ-9）来回顾性计算有记录的抑郁症筛查的基线率。然后，我们让关键利益相关者参与制定诊所中正式抑郁症筛查的临床工作流程。我们还向提供者提供了关于 c-SLE 中心理健康障碍的教育，重点介绍了患病率、筛查方法和阳性筛查的管理。然后，我们使用 QI 的计划-执行-研究-行动（PDSA）方法实时系统地评估和调整我们的流程。主要结果是每月接受过 c-SLE 治疗的患者中，过去一年有记录的 PHQ-9 筛查的百分比。
在项目启动后的 12 个月内，记录 PHQ-9 结果的儿童比例从基线时的 0%到 4.5%上升到 91.0%。在项目结束时，每月筛查率大于 80%的情况已经持续了 10 个月。由于这些努力，有 27 名（48.2%）至少有轻度抑郁症状的患者被识别出来，有 7 名（12.5%）有自杀念头的患者被转介到适当的心理健康资源。
在繁忙的亚专科诊所中进行常规的正式抑郁症筛查是可行的。通过使用 QI 方法，c-SLE 儿童的正式抑郁症筛查率从每月平均 3.3%增加到持续每月大于 80%的水平。识别出有抑郁症状和/或自杀念头的个体，并将其转介到适当的心理健康资源。
