Evaluating Clinical Decision Supports to Improve Adolescent Depression Screening and Management in Pediatric Primary Care.

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics Pub Date : 2025-04-22 DOI:10.1016/j.acap.2025.102839

Nathaniel J Glasser, Camron Shirkhodaie, Zachary C Newman, Joanne Wang, Mengqi Zhu, James W Mitchell, Erin Staab, Stephanie Lichtor, Neda Laiteerapong

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引用次数: 0

Abstract

Objectives: To examine how depression screening rates changed after implementation of electronic health record (EHR) clinical decision support tools and medical assistant (MA)-led depression screening at an outpatient pediatric practice.

Methods: We assessed changes in depression screening rates at an urban academic pediatric clinic between September 2016-December 2020 using interrupted time series analysis. During this time, we implemented (1) EHR clinical decision support tools for depression screening and management (November 2017) and (2) training of MAs to screen for depression (July 2019).

Results: Over the study period, 3,963 patients received care in the pediatric clinic. Their mean age was 14.9 years (SD, 2.6) and about half were female (n=2,011, 51%). The majority were Black/African American (n=2,852, 72%) and had private insurance (n=2,860, 72%). Depression screening rates increased from 3% to >80%. Pre-intervention, depression screening rates were not increasing (0.9% per month, 95% CI: -0.3 to 2.1%; p=0.15). After implementing EHR clinical decision support tools, there was a 15.6% (95% CI: 2.5-28.6%, p=0.02) increase in the screening rate. Also, MA-led screening was associated with a 24.6% (95% CI: 9.9-39.2%, p=0.002) screening rate increase.

Conclusions: This study demonstrates that EHR clinical decision support tools and MA-led screening are likely to increase adolescent depression screening and management in pediatric clinics.

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评估临床决策支持以改善儿童初级保健中青少年抑郁症筛查和管理。

目的：研究在门诊儿科实践中实施电子健康记录（EHR）临床决策支持工具和医疗助理（MA）主导的抑郁症筛查后，抑郁症筛查率的变化。方法：我们使用中断时间序列分析评估了2016年9月至2020年12月期间城市学术儿科诊所抑郁症筛查率的变化。在此期间，我们实施了(1)用于抑郁症筛查和管理的EHR临床决策支持工具（2017年11月）和(2)培训MAs筛查抑郁症（2019年7月）。结果：在研究期间，3963例患者在儿科诊所接受了治疗。他们的平均年龄为14.9岁（标准差为2.6），约一半为女性（n= 2011, 51%）。大多数是黑人/非裔美国人（n=2,852, 72%），有私人保险（n=2,860, 72%）。抑郁症筛查率从3%增加到80%。干预前，抑郁症筛查率没有增加(每月0.9%,95% CI: -0.3至2.1%；p = 0.15)。实施电子病历临床决策支持工具后，筛查率提高了15.6% （95% CI: 2.5-28.6%, p=0.02）。此外，ma引导的筛查与24.6% （95% CI: 9.9-39.2%, p=0.002）的筛查率增加相关。结论：本研究表明，电子病历临床决策支持工具和ma主导的筛查可能会增加儿科诊所的青少年抑郁症筛查和管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Academic Pediatrics PEDIATRICS-

CiteScore

4.60

自引率

12.90%

发文量

300

审稿时长

60 days

期刊介绍： Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy,and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.