Suicide remains a leading cause of death for youth ages 10-24, but early identification of mental health issues can prevent it. This pediatric hospital had processes to screen patients for depression but sought to improve the identification of depression among adolescent patients. By implementing new processes, the organization decreased variation and ensured adolescent patients receive depression screening at least once yearly to support improved mental health.
Adolescence is often a challenging time as teens go through numerous physical, emotional, psychological, and social changes. These changes can make teens vulnerable to mental health problems that lead to severe outcomes. By 2018, suicide was the second leading cause of death for youth ages 10-24. The COVID-19 pandemic accelerated the worsening crisis in adolescent mental health, including depression in teens, dramatically increasing the number of adolescents visiting emergency departments for mental health emergencies and suspected suicide attempts.1
At this pediatric hospital, mental health is as important as physical health. The organization was acutely aware that the mental health crisis among teens was accelerating. The organization recognized that while one in five teens have a diagnosable mental health condition, only one-third of those teens are diagnosed and treated.
Early identification of mental health issues and intervention can prevent severe manifestations, such as suicidal ideation and suicide, and can also prevent emergency department visits and mental health admissions. The organization developed comprehensive mental health services and had some processes in place to screen patients for depression, but processes varied, and the organization wasn’t confident it was screening all patients. It sought to improve the identification of depression among adolescent patients so it could further enhance the support and treatment offered.
The organization implemented new processes to decrease variation and ensure adolescent patients 12-18 years old who receive care in its primary care or specialty clinics receive regular depression screening. The organization engaged physicians in selecting a standard depression screening tool and committed the physicians to screening all adolescent patients 12-18 years old at least once a year. The pediatric hospital started its improvement efforts by focusing on adolescents coming in for well-child visits and then expanded screening to all visit types.
When adolescent patients 12-18 years old present to the clinic, decision support tools in the EHR help the pediatric hospital care team members identify if the patient has been screened for depression within the last year. Patients who have not been screened are provided the depression screening form. Care team members collect the results and enter the data into the patient’s medical record for providers to review during the patient visit.
The depression risk scores resulting from the screening are stratified, and the care team provides patients with resources corresponding to their risk level.
The pediatric hospital leverages the high-value data and analytics from the Health Catalyst® data platform and a robust suite of analytics applications to visualize screening performance, enabling real-time tracking of depression screening rates. The organization integrates social determinants of health data (SDoH) into the analytics application and can visualize performance by different demographic and SDoH variables.
Using data from the data platform, the organization can quickly identify ongoing improvement opportunities. The organization uses the data to guide improvement efforts, reaching out to clinics and providers with lower than desired screening rates, sharing data, and collaborating to identify process changes to ensure more patients receive depression screening and mental health care.
The pediatric hospital's data-informed improvement efforts are improving the mental health of the patients and families in its care. In just one year, the organization achieved:
"The high-value data and analytics in the analytics application have been invaluable. We can evaluate performance day to day, week to week, month to month, enabling us to focus our improvement efforts and substantially increase the number of adolescents screened and treated for depression."
Assistant Chief Medical Officer; VP and Executive Medical Director
The pediatric hospital plans to further expand depression screening across all care sites, improving the recognition and treatment of adolescents with depression. In addition, the organization plans to improve mental health referral processes, ensuring patients can easily and efficiently access needed care.
