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Pre-post Evaluation of Automated Reminders May Improve Detection and Management of Post-stroke Depression

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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.

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Acknowledgements

This project was supported by a VA HSR&D Merit Review grant (IMV 04–096) and the VA HSR&D Stroke QUERI (STR 03–168). Portions of these data were presented at the VA National QUERI meeting, Phoenix, AZ, 12/11/2008 and at the American Stroke Association International Stroke Meeting, San Antonio, TX, 2/19/2010.

Conflicts of Interest Statement

There are no known conflicts of interest with any of the authors that relate to the work done in this project.

Author information

Authors and Affiliations

  1. Roudebush VAMC and VA Stroke QUERI, Indianapolis, IN, USA

    Linda S. Williams MD, Laurie Plue MA & Teresa Damush PhD

  2. Indiana University, Department of Neurology, 1481 West 10th Street, Indianapolis, IN, 46202, USA

    Linda S. Williams MD

  3. Regenstrief Institute, Inc, Indianapolis, IN, USA

    Linda S. Williams MD & Teresa Damush PhD

  4. Indiana University, Department of Medicine, Indianapolis, IN, USA

    Susan Ofner MS, Zhangsheng Yu PhD & Teresa Damush PhD

  5. Dept. of Medicine, Division of Internal Medicine, NF/SGVHS GRECC and University of Florida College of Medicine, Gainesville, FL, USA

    Rebecca J. Beyth MD MSc

Authors
  1. Linda S. Williams MD
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  2. Susan Ofner MS
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  3. Zhangsheng Yu PhD
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  4. Rebecca J. Beyth MD MSc
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  5. Laurie Plue MA
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Corresponding author

Correspondence to Linda S. Williams MD.

Electronic Supplementary Material

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Online Appendix

Table 4. ICD-9 codes used to identify ischemic stroke and depression diagnoses (PDF 22 kb)

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Williams, L.S., Ofner, S., Yu, Z. et al. Pre-post Evaluation of Automated Reminders May Improve Detection and Management of Post-stroke Depression. J GEN INTERN MED 26, 852–857 (2011). https://doi.org/10.1007/s11606-011-1709-6

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  • DOI: https://doi.org/10.1007/s11606-011-1709-6

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