Improving Coordinated Mental Health Care Through an Enhanced Referral Process: A Quality Improvement Project

As the incidence of major depressive disorders continues to rise, the need for depression screening in primary care is imperative. The objective of this quality improvement (QI) project is to increase depression screening and enhance the current referral process in an urban primary care setting in the southeast United States. To achieve a projected increase in identified depression within the current and future adult patient population, workflow processes have been restructured to incorporate consistent depression screening using the Patient Health Questionnaire-2 (PHQ-2) and -9 (PHQ-9). Revised clerical workflow processes include initiating PHQ-9 questionnaires for all new patients, while clinical workflow processes include conducting PHQ-2 questionnaires for all established patients. Scores on the PHQ-9 indicating moderate levels of depression will trigger primary care provider (PCP) notification. Providers offer three treatment options including Behavioral Health Care Navigator Services (BHCN), self-referral to a mental health care provider, or treatment by PCP. Data will be collected to determine the number of PHQ-9 questionnaires given to “New Patients” at check-in, PHQ-2 questionnaires conducted by clinical staff, PHQ-9 scores of 10 or greater, BHCN referrals placed, patients who elected self-referral, and completed initial mental health appointments with differentiation between BHCN scheduled appointments and self-referred appointments. This QI project is currently undergoing implementation with no outcomes to report, however, data collected during analysis is expected to reveal an increase in patients diagnosed with moderate to major depressive disorders and an increase in completed initial mental health appointments