Date of Degree

Summer 2025

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type

Doctoral

Degree Name

Doctor of Nursing Practice

Abstract

Problem: Primary care settings often encounter patients with depression symptoms, characterized by feelings of sadness, lack of interest in activities, and functional impairment, impacting quality of life. At the project site, the PHQ-9 was only used during annual or new patient visits, resulting in low screening rates of 12% and a 33% referral rate. The lack of routine screening led to missed opportunities for mental health referrals and detection of depression.

Aim of the Project: The aim of the project was to increase mental health referral rates through early identification of depression symptoms by implementing routine PHQ-2 screens.

Review of the Evidence: Literature supports the use of the PHQ-2 as a validated and brief pre-screening tool for patients at risk for depression. When followed by the PHQ-9 diagnostic accuracy is increased and timely referrals can be made. Literature demonstrates the positive impact on outcomes and integration into primary care when utilizing this two-step screening process.

Project Design: A quality improvement (QI) initiative using the OhioHealth Change Management (OHCM) Model and two Plan-Do-Study-Act (PDSA) cycles guided the implementation. A multi-disciplinary team included administrative leadership, a physician, nurse practitioners, LPN, front desk staff, and IT. Weekly data review and capture of stakeholder feedback occurred throughout implementation.

Intervention: PHQ-2 screening was integrated into the electronic health record (EHR) for every patient visit. PDSA Cycle 1 solved a workflow gap ensuring that positive PHQ-2 results triggered the PHQ-9. PDSA Cycle 2 addressed onboarding new staff using education to inform the workflow and using teach-back methods to ensure comprehension for new staff.

Significant Findings/Outcomes: Rates of screening increased from 12% to 100%, and the referral rate from 33% to 47.4%. Final change readiness surveys showed full confidence by all staff in the workflow and availability of resources.

Implications for Nursing: This nurse-led QI project showed that a structured workflow, validated screening tools and stakeholder engagement improved mental health referrals and detection of depression in a primary care setting. The QI project aligned with the IHI Triple Aim as well as the IOM Six Aims by supporting access, timeliness, and patient-centeredness of care delivery.

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