Teryn Bruni1, Leah LaLonde2, Alexandros Maragakis2, Joyce Lee3, Abigail Caserta3, Amy M Kilbourne4, Shawna Smith5, Kelly Orringer3, Joanna Quigley3, Harlan McCaffery3, Blake Lancaster3. 1. Department of Pediatrics, Michigan Medicine (T Bruni, J Lee, A Caserta, K Orringer, J Quigley, H McCaffery, and B Lancaster), Ann Arbor, Mich. Electronic address: tbruni@med.umich.edu. 2. Psychology Department, Eastern Michigan University (L LaLonde and A Maragakis), Ypsilanti, Mich. 3. Department of Pediatrics, Michigan Medicine (T Bruni, J Lee, A Caserta, K Orringer, J Quigley, H McCaffery, and B Lancaster), Ann Arbor, Mich. 4. VA Ann Arbor Healthcare System and Michigan Medicine, Learning Health Sciences, University of Michigan (AM Kilbourne), Ann Arbor, Mich. 5. School of Public Health, University of Michigan (S Smith), Ann Arbor, Mich.
Abstract
OBJECTIVE: The aim of the current study was to evaluate primary care pediatrician (PCP) adoption of an electronic health record (EHR) documentation tool and their delivery of a behavioral activation (BA) intervention within their routine practice with adolescents who screened positive for depression. METHODS: We used the RE-AIM framework to describe PCP adoption and implementation of EHR documentation tools and brief evidence-based protocols. Utilization was assessed using a customized toolbar (ie, actions toolbar) via retrospective chart review. A pre-post design was used to measure changes in PCP-reported knowledge, comfort, and feasibility managing depression before and after they were trained. A mixed-effects logistic regression model was used to analyze associations of resource utilization with depression severity. RESULTS: PCPs used the actions toolbar to document responses to elevated Patient Health Questionnaire (PHQ-9) scores for 29.80% of encounters. The PCPs utilized the BA protocol for 10.5% of encounters with elevated PHQ-9 scores. Higher depression severity categories were associated with significantly higher odds of utilization relative to mild severity. The training was rated highly acceptable and PCPs reported significant post-training increases in comfort and feasibility. CONCLUSION: This is the first study of its kind to implement and evaluate PCP utilization of an EHR documentation tool aimed to improve delivery of an evidence-based intervention for adolescent depression. Teaching PCPs to implement brief interventions has potential to increase access to evidence-based care; however, large-scale practice change requires an effective implementation strategy that does not increase provider burden and is fully integrated into physician documentation and workflow.
OBJECTIVE: The aim of the current study was to evaluate primary care pediatrician (PCP) adoption of an electronic health record (EHR) documentation tool and their delivery of a behavioral activation (BA) intervention within their routine practice with adolescents who screened positive for depression. METHODS: We used the RE-AIM framework to describe PCP adoption and implementation of EHR documentation tools and brief evidence-based protocols. Utilization was assessed using a customized toolbar (ie, actions toolbar) via retrospective chart review. A pre-post design was used to measure changes in PCP-reported knowledge, comfort, and feasibility managing depression before and after they were trained. A mixed-effects logistic regression model was used to analyze associations of resource utilization with depression severity. RESULTS: PCPs used the actions toolbar to document responses to elevated Patient Health Questionnaire (PHQ-9) scores for 29.80% of encounters. The PCPs utilized the BA protocol for 10.5% of encounters with elevated PHQ-9 scores. Higher depression severity categories were associated with significantly higher odds of utilization relative to mild severity. The training was rated highly acceptable and PCPs reported significant post-training increases in comfort and feasibility. CONCLUSION: This is the first study of its kind to implement and evaluate PCP utilization of an EHR documentation tool aimed to improve delivery of an evidence-based intervention for adolescent depression. Teaching PCPs to implement brief interventions has potential to increase access to evidence-based care; however, large-scale practice change requires an effective implementation strategy that does not increase provider burden and is fully integrated into physician documentation and workflow.