Improving mental health screening at a large cystic fibrosis center

Background: People with cystic fibrosis (CF) are 2-3 times more likely to experience depression, anxiety, or both Untreated depression and anxiety can affect both physical and emotional health Left untreated, people with CF are less likely to manage their treatment plans effectively, have worse lung function, have a lower BMI, and experience more hospitalizations At Boston Children's Hospital/Brigham and Women's Hospital combined pediatric and adult CF center, we have 598 patients total (274 in the pediatric program and 324 in the adult program) 79% of our patients are over 12 and eligible for depression and anxiety screening Our pediatric care team consists of 15 MDs/NPs and 2 social workers Our adult care team consists of 7 MDs/NPs and 1 social worker There is 1 psychologist that sees both pediatric and adult patients Objectives: (1) To streamline mental health screening process, (2) improve mental health screening rates for our CF pediatric and adult populations, and (3) identify patients who need further mental health services Methods: To ensure we address mental health, we developed a new process for distributing the PHQ-9 assessment tool for depression and GAD-7 assessment tool for anxiety We implemented a screening note template into our electronic medical record for better documentation of completed screens and began including mental health screens as a part of the weekly pre-visit planning amongst clinicians, nurses, and social workers We refined the process to allow for our clinic administrators to hand out the assessments to patients at check-in and nursing assisted in collecting the screens and responding appropriately depending on the score Results: Our average mental health screening rate in 2018 was 46% for the pediatric program and 71% for the adult program After implementing our new process in 2019, our screening rates increased to 71% for the pediatric program and 83% for the adult program With increased rates of screening, we did not observe a significant difference in the percentage of patients screening at-risk A majority of patients scored in the minimal-mild range on both the PHQ-9 and GAD-7 On the PHQ-9, 8% scored in the moderate range (vs 7% in 2018) and 2% scored in the severe range (vs 2% in 2018) On the GAD-7, 10% scored in the moderate range (vs 9% in 2018) and 3% scored in the severe range (vs 6% in 2018) On question #9, 98% indicated “not at all” (vs 96% in 2018) Conclusion: Our mental health screening process has become an embedded part of our CF clinic flow Our process has led to sustained increases in mental health screening rates Future work will focus on follow-up on mental health treatment referrals In addition, with the rapid shift to telehealth due to COVID, we are adapting our process to account for telehealth visits