Journal of General Internal Medicine, 2011, Vol.26(8), pp.852-857
Byline: Linda S. Williams (1,2,3), Susan Ofner (4), Zhangsheng Yu (4), Rebecca J. Beyth (5), Laurie Plue (1), Teresa Damush (1,3,4) Keywords: depression; stroke; quality improvement; computerized reminders Abstract: Background Post-stroke depression (PSD) occurs in at least one-third of stroke survivors, is associated with worse functional outcomes and increased mortality, and is frequently underdiagnosed and undertreated. Objective To evaluate the effectiveness of an electronic medical record-based system intervention to improve the proportion of veterans screened and treated for PSD. Design Quasi-experimental study comparing PSD screening and treatment among veterans receiving post-stroke outpatient care one year prior to the intervention (the control group) to those receiving outpatient care during the intervention period (the intervention group) contemporaneous data from non-study sites included to assess temporal trends in depression diagnosis and treatment. Participants Veterans hospitalized for ischemic stroke and/or receiving primary care (PC) or neurology outpatient follow-up within six months post-stroke at two (Veterans Affairs) VA Medical Centers. Interventions We formed clinical improvement teams at both sites. Teams developed PSD screening and treatment reminders and designed tailored implementation strategies for reminder use in PC and neurology clinics. Main Measures Proportion screened for PSD within 6 months post-stroke proportion screening positive for PSD who received an appropriate treatment action within 6 months post-stroke. Key Results In unadjusted analyses, PSD screening was performed within 6 months for 85% of intervention (N=278) vs. 50% of control (N=374) patients (OR 6.2 , p〈0.001), and treatment action was received by 83% of intervention vs. 73% of control patients who screened positive (OR 1.8 p=0.13). After adjusting for intervention, site and number of follow-up visits, intervention patients were more likely to be screened (OR 4.8, p〈0.001) and to receive a treatment action if screened positive (OR 2.45, p=0.05). Analyses of temporal trends in non-study sites revealed no trend toward general increase in PSD detection or treatment. Conclusions Automated depression screening in primary and specialty care can improve detection and treatment of PSD. Author Affiliation: (1) Roudebush VAMC and VA Stroke QUERI, Indianapolis, IN, USA (2) Indiana University, Department of Neurology, 1481 West 10th Street, Indianapolis, IN, 46202, USA (3) Regenstrief Institute, Inc, Indianapolis, IN, USA (4) Indiana University, Department of Medicine, Indianapolis, IN, USA (5) Dept. of Medicine, Division of Internal Medicine, NF/SGVHS GRECC and University of Florida College of Medicine, Gainesville, FL, USA Article History: Registration Date: 22/03/2011 Online Date: 16/04/2011 Article note: Electronic Supplementary Material The online version of this article (doi: 10.1007/s11606-011-1709-6) contains supplementary material, which is available to authorized users.
depression ; stroke ; quality improvement ; computerized reminders
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