1. What evidence are you proposing to translate into practice?
I propose to develop a program at the General Medicine Clinic to increase the number of people who receive a full diagnostic interview for depression after a positive 2 question screen for depressive symptoms.
A. Justify that this evidence is “ready for translation.”
The United States Preventive Services Task Force (USPSTF) recommends screening for depression among adults 18 years old or older if staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up. The task force notes that treatment of depression leads to improved depression and improved quality of life. Additionally, given that depression comorbid with other chronic diseases such as coronary artery disease or diabetes leads to poorer outcomes, it may be possible that treating depression may have some impact on other chronic diseases (though in many cases that evidence has been mixed). Given that GMC has instituted the 2 question depression screen, it is important to make sure that the screen is followed by a full diagnostic interview, per USPSTF guidelines. There are behavioral teams, psychiatric referrals, and community therapy referrals in place to support those individuals who screen positive and have a positive subsequent diagnostic interview.
B. Identify a single, key behavior change target for your translational activity.
I propose the GMC Health Care Delivery System as the target of behavioral change. This will include providers, medical assistants, behavioral staff, and nurses.
2. Conduct a “gap analysis” of your target behavior. Look to diverse sources for “best guess” estimates if specific measures are not available.
A. What is the quality (performance) gap?
Per the U.S. Department of Health and Human Services, less than 5% (between 1.6% and 3%) of primary care visits included depression screening. Yet depression is estimated to affect 1 in 10 U.S. adults.
B. What is the outcome gap?
Unless people are screened and diagnosed with depression, they cannot be initiated on appropriate treatment (including medications, therapy, referrals to psychiatry).
3. Is there evidence that changing performance will improve health (clinical outcomes)?
There is evidence that screening for and treating depression improves depressive symptoms, and quality of life, as noted above. It is not yet clear what effect, if any, that treating depression may have on comorbid chronic diseases. However, given the frequent co-occurrence of depression and chronic diseases, and worse outcomes when depression is present, it is possible that treating depression could also favorably impact other conditions. There is little evidence of harm of screening and treating for depression.