871-P: Integrating the PHQ-A Depression Screening Tool within the Electronic Health Record Increases Detection of Depression Symptoms

Depression symptoms are common for youth with diabetes and may negatively affect quality of life and health outcomes. In our large, urban, pediatric diabetes clinic, depression screening with a condensed, verbally-administered measure, the Patient Health Questionnaire-2 (PHQ-2), had a positivity rate of only 2%, which is far below anticipated rates. We developed a quality improvement project to increase the sensitivity of depression screening for youth with diabetes. The primary test of change was electronically administering the Patient Health Questionnaire for Adolescents (PHQ-A), a 13-question survey validated for use in pediatrics. Youths ≥ 12 years of age were asked to privately complete the PHQ-A on a laptop at a diabetes visit annually. Responses populated within the electronic health record, and medical providers were trained to respond to positive screens with the support of a social worker or psychologist. A run chart was used to assess screen-positivity rate over time; ≥6 points above the baseline was considered a significant change. During the study period (August 2018—February 2020), 740 PHQ-A screens were completed by 618 patients. The majority of patients (n = 489; 79%) had type 1 diabetes, 50% were female, and the median age (IQR) at screening was 16.2 (14.0-18.0) years. On average, 38.9 screens/month were completed (range: 16-70), and 6.8 screens/month were positive (range: 0-16). Of all completed screens, 129 (17.4%) were positive. The positivity rate was greater than baseline for all 7 quarters evaluated after implementation of PHQ-A. Of the positive screens, 55 (43%) were positive due only to SI or SA history. Using a standardized and easily administered approach, the detection of depression symptoms increased to a range comparable to previous reports. The number of completed screens per month was manageable, allowing us to promptly address depression symptoms within our interdisciplinary clinic workflow. Disclosure J. Gettings: None. S. M. Willi: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Medtronic, Other Relationship; Self; National Institute of Diabetes and Digestive and Kidney Diseases. O. Patil: None. M. Vajravelu: None. C. P. Hawkes: None. A. Tuttle: None. M. Buzby: None. S. Crean: None. M. B. Dever: None. L. Mulligan: None.