Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA.
Division of Pediatric Hematology and Oncology, Helen DeVos Children's Hospital at Corewell Health, Grand Rapids, Michigan, USA.
J Adolesc Young Adult Oncol. 2024 Oct;13(5):768-775. doi: 10.1089/jayao.2023.0125. Epub 2024 May 6.
Adolescents and young adults (AYA) with chronic illnesses experience an increase in mental health concerns. A mental health screening (MHS) process for hematology and oncology patients was implemented in a single institution. The quality improvement project was conducted to integrate a MHS process, educate providers about the importance of mental health in this patient population, and evaluate the process. The COM-B (capability, opportunity, motivation-behavior) model for behavior change was used to inform strategic planning and Plan-Do-Study-Act (PDSA) methodologies for process improvement. Retrospective chart reviews and surveys were conducted to determine missed screening rates and providers' perceptions, knowledge, attitudes, and skills of the MHS process. Of 334 eligible patient encounters, the missed screening rate was 15.0%, the overall error rate of completing the screening was 3.8%, the error rate of completing the suicide or self-harm indicator was 2.6%, and the missed medical social worker touch point was 4.8%. The rising rates of mental health concerns in AYA hematology and oncology patients call for streamlined MHS processes to improve the identification of patients who may need intervention and services. Processes should be tailored to workflows and available resources. Future PDSA cycles will include providing dedicated nursing education and determining the cost needed to meet the rising mental health needs of the AYA hematology and oncology population.
青少年和年轻成人（AYA）患有慢性疾病会增加心理健康问题。在一家医疗机构实施了血液学和肿瘤患者心理健康筛查（MHS）流程。该质量改进项目旨在整合 MHS 流程，使提供者了解该患者群体心理健康的重要性，并评估该流程。行为改变的 COM-B（能力、机会、动机-行为）模型用于为战略规划提供信息，并为流程改进采用计划-执行-研究-行动（PDSA）方法。通过回顾性图表审查和调查，确定了漏筛率以及提供者对 MHS 流程的看法、知识、态度和技能。在 334 例符合条件的患者就诊中，漏筛率为 15.0%，完成筛查的总体错误率为 3.8%，完成自杀或自残指标的错误率为 2.6%，错过医疗社工接触点的比例为 4.8%。AYA 血液学和肿瘤患者的心理健康问题发生率不断上升，这要求简化 MHS 流程，以提高识别可能需要干预和服务的患者的能力。流程应根据工作流程和可用资源进行调整。未来的 PDSA 循环将包括提供专门的护理教育，并确定满足 AYA 血液学和肿瘤患者不断增长的心理健康需求所需的成本。
