Date of Award

Spring 5-21-2019

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Kevin J. Maxwell, DNP, FNP-BC, RN


Purpose: Evaluation of an evidence-based protocol that measures the effectiveness of universal depression screening at an integrated healthcare center. At risk patients are those who complete a patient health questionnaire (phq-9) and score ≥ 10 when presenting for a primary care visit. A score of ≥ 10 prompts further evaluation by the primary care provider (PCP) prior to behavioral health care management (BHCM) referral.

Background: In 2016, 16.2 million adults aged 18 or older in the U.S. experienced a major depressive episode (MDE). 65.3% of those received some form of treatment from a healthcare professional (therapy and/or medication). Early identification of patients who may benefit from mental/behavioral health services has been shown to improve outcomes and reduce costs. An evidence-based collaborative care protocol at an integrated health care center can help decrease the financial burden of a disorder that was shown to have a financial impact of $210.5 billion in the U.S. in 2015.

Process: A retrospective analysis of a universal depression screening protocol implemented at an integrated health care center on February 1, 2018. The process involves completion of a phq-9 questionnaire via the patient link electronic system prior to being evaluated by the PCP. Scores of ≥ 10 are flagged. The PCP assesses the score with the patient. If in agreement, the behavioral health care management referral is placed and a warm hand off is done from the PCP to the care manager. The care manager will further assess the patient in order to appropriately utilize mental/behavioral health services. Weekly reports from IT of all flagged phq-9 are reviewed by care managers.

Outcomes: With the introduction of electronic patient link questionnaire tablets, a 56% screening rate via phq-9 questionnaires was discovered. Behavioral health care management referrals were appropriately ordered 77% of the time. Appointments, show rates, and BH services utilized will be presented.

Conclusion: Mental health issues account for up to 70% of primary care visits. PCPs correctly diagnose depression as little as 25% of the time. It is imperative that an integrated health care center establish an effective collaborative care protocol shown to improve healthcare equity, patient outcomes and disease burden/costs.