Improving the Rates of Objective Monitoring of Patients with Depression with the PHQ-9 in an Outpatient Psychiatry Clinic: A Quality Improvement Initiative.

BACKGROUND

Despite evidence that measurement-based care (MBC) can help identify nonresponse and residual depressive symptoms and could improve treatment, it is underused. The aim of this study was to improve the percentage of patients with depression who received symptom monitoring using the Patient Health Questionnaire-9 (PHQ-9) from 5% to 90%.

METHODS

The research team conducted a quality improvement project employing an uncontrolled before [January to September 2020] and after [October 2020 to May 2021] approach. Researchers used the Model for Improvement (MFI) methodology framework to design the project. The interventions included two education sessions for physicians and the flagging of charts of patients with depression as a visual reminder. Data on the rate of monitoring were collected prospectively each month and extracted after reviewing the paper charts (to determine whether the PHQ-9 was completed by the physician and part of the chart or the PHQ-9 score was documented in the physicians' follow-up note).

RESULTS

Prior to the start of the quality improvement initiative the rate of objective monitoring using a rating scale in the clinic was 5.1%. A total of 230 patients were included in the initiative. All physicians attended the educational sessions. By June 2021 the rate of monitoring patients' depressive symptoms and illness severity using the PHQ-9 improved to an average of 51.3% (over the intervention period of October 2020 until May 2021).

CONCLUSION

This initiative reiterates that education strategies, alone or in tandem with visual reminders, could be used to improve the rates of objective symptom monitoring and illness severity of patients with depression. Future studies should aim to determine if the improvement in PHQ-9 utilization is associated with better outcomes for this population.