A Quality Improvement Endeavor Improving Depression Screening for Rural Older Adults

Abstract

Purpose: Develop a quality improvement plan to begin a biphasic depression screening process for rural people 65 years and older residing in two counties in south-central Nebraska.  Sample: Project initiation involved retrospective chart review of a convenience sample of 50 adults, 65 years or older with a known diagnosis of anxiety or depression residing in south-central Nebraska.

Method: A quality improvement design based on the plan-do-study-act (PDSA) model, charts a prescribed four-stage cyclic learning process while compatible with the Promoting Action on Research Implementation in Health Services Framework (PARiHS) model for evidence-based practice (EBP), emphasizing the significance of organizational culture.  An interprofessional (IP) small-team approach provided momentum into full organization expansion through a three-cycle operational plan.

Findings: The project used descriptive statistics providing aggregate demographic data while delivering a means to measure progress towards goal acquisition.

Conclusion: Use of the convenience sample indicated the need to standardize secondary depression screening processes within a vulnerable rural population.  Outcomes demonstrate goal achievement with the consistent use of electronic medical record (EMR) supported Patient Health Questionnaire (PHQ-2) data for the older adult. However, a breakdown occurred when the organization was reliant on face-to-face communication in notifying the healthcare provider when the PHQ-2 triggered the need for the more detailed PHQ-9.  A gap in primary care for older men discovered with implications for improving the accessibility of healthcare in the future. 

DOI: https://doi.org/10.14574/ojrnhc.v19i2.563