Background/Objective: Routine monitoring for depression with a validated tool is recommended for patients with diabetes according to American Diabetes Association Standards of Medical Care. This quality improvement (QI) project aimed to increase depression screening at a Pediatric Diabetes Center by 50% over 3 months.

Methods: The PHQ-4 was identified to assess depression and anxiety for patients 11 and older. It asks four questions assessing distress (two from GAD-7 assessing anxiety, two from PHQ-9 assessing depression). If elevated scores are reported in either subgroup, the full GAD-7 and/or PHQ-9 are provided. Rates of screening were tracked monthly. Workflow was as follows: patient identification in rounds; PHQ-4 completion at check-in; provider review/input into EHR; provider psychoeducation and support. Multiple Plan-Do-Study-Act (PDSA) cycles were performed (provider education, patient handouts, paper to online administration (using a QR code).

Results: Prior to implementation, baseline depression screening was 0-4%. Following QI efforts, monthly depression screening rates were between 50-83%. The PHQ-4 was administered to 143 subjects. Positive distress was reported in 21 instances (16 unique patients) (10 = mild, 6 = moderate, 5 = severe). Patients were referred to community support (n = 6), social work (n = 3), neuropsychology/psychology (n = 5), or declined (n = 2).

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