Date of Degree
Summer 2025
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
First Advisor
Lydia Forsythe, PhD, MA, MSN, RN, CNOR
Second Advisor
Amanda Graham DNP, MSN, RN-BC, AMB-BC
Third Advisor
Melanie Brewer, DNSc, RN, FNP-BC, NEA-BC, FAANP
Abstract
Problem: About one-third of the 129 million chronically ill patients in the United States experience persistent depressive symptoms. Approximately 300 of 500 (60%) chronically ill patients treated at the project site each month show signs of depression, indicating a higher prevalence than the national rate of 33.33%. Despite the critical role of family practice in identifying and managing depression, many patients are not adequately screened, leading to missed opportunities for early diagnosis and treatment. The project site does not use the digitized PHQ screening tool to screen patients for depression. An analysis of patient charts revealed that, out of about 1800 patients diagnosed with depression at the project site over the past six months, only 828 (46%) were screened using the manual PHQ, resulting in very low Healthcare Effectiveness Data and Information Set (HEDIS) scores. High adherence to HEDIS depression measures is often associated with better overall care and higher patient satisfaction scores. Meeting HEDIS scores will support increased reimbursement rates, performance-based bonuses, and value-based care incentives from most insurance companies.
Aim of the Project: The overarching aim of the quality improvement project was to implement the PHQ screening tool in a family practice clinic to enhance HEDIS depression scores.
Review of the Evidence: Several studies have validated the PHQ screening tool as an effective and efficient method for assessing depression in outpatient family practice clinics. According to Gómez-Gómez et al. (2023), the PHQ has a sensitivity of 89% and a specificity of 90% for major depression. Moreover, the United States Preventive Services Task Force (USPSTF) strongly recommends routine screening for individuals aged 12 and older, with appropriate follow-up intervention (Costantini et al., 2021). A comprehensive screening approach that integrates the PHQ into the electronic health record (EHR) system, along with systematic and routine follow-up screening and assessment, can significantly improve depression detection and contribute to higher HEDIS scores.
Project Design: The quality improvement project was designed in a family practice clinic outpatient setting with a diverse patient population, including those with acute and chronic diseases. The purpose is to evaluate and implement the PHQ screening tool for depression screening to enhance clinical benchmarking and performance for HEDIS measures. The framework utilized is the Plan-Do-Study-Act model, as well as the OhioHealth Change Management model.
Intervention: The intervention involved three clinical providers, including nurses and a medical assistant. It involved integrating the PHQ screening tool into the electronic health record (EHR) as part of the standardized intake process for patients aged 12 and older with acute or chronic conditions. Patients who screened positive (PHQ-2 score ≥ 3) were promptly administered the PHQ-9 by nurses or the clinical provider during the same encounter. The workflow was reinforced through daily and weekly huddles, staff training, and accurate documentation of ICD-10 codes in the EHR, ensuring proper capture of ICD-10 codes for quality metrics, HEDIS measures review, follow-up plans, and treatment interventions.
Significant Findings/Outcomes: The depression screening rate increased from less than 46% to 93.86%, the depression detection rate increased from less than 10% to 91.2%, and patient follow-up rates increased from less than 45% to 98.13% surpassing the HEDIS benchmark of 85%.
Implications for Nursing: The PHQ screening tool is an evidence-based intervention that can significantly enhance depression screening and detection, as well as improve patient follow-up rates, ultimately leading to better HEDIS scores. Nurses play a vital role in the screening process, supporting clinical diagnosis and enhancing clinical outcomes.
Recommended Citation
Akaeze, Dorothy, "Utilizing the Patient Health Questionnaire in a Family Practice Clinic to Enhance Clinical Benchmarks" (2025). Doctor of Nursing Practice (DNP) Scholarly Project. 33.
https://fuse.franklin.edu/dnp-project/33
Rights
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