Pre-post evaluation of automated reminders may improve detection and management of post-stroke depression

Linda Williams, Susan Ofner, Zhangsheng Yu, Rebecca J. Beyth, Laurie Plue, Teresa Damush

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Post-stroke depression (PSD) occurs in at least one-third of stroke survivors, is associated with worse functional outcomes and increased mortality, and is frequently underdiagnosed and undertreated. Objective: To evaluate the effectiveness of an electronic medical record-based system intervention to improve the proportion of veterans screened and treated for PSD. Design: Quasi-experimental study comparing PSD screening and treatment among veterans receiving post-stroke outpatient care one year prior to the intervention (the control group) to those receiving outpatient care during the intervention period (the intervention group); contemporaneous data from non-study sites included to assess temporal trends in depression diagnosis and treatment. Participants: Veterans hospitalized for ischemic stroke and/or receiving primary care (PC) or neurology outpatient follow-up within six months post-stroke at two (Veterans Affairs) VA Medical Centers. Interventions: We formed clinical improvement teams at both sites. Teams developed PSD screening and treatment reminders and designed tailored implementation strategies for reminder use in PC and neurology clinics. Main Measures: Proportion screened for PSD within 6 months post-stroke; proportion screening positive for PSD who received an appropriate treatment action within 6 months post-stroke. Key Results: In unadjusted analyses, PSD screening was performed within 6 months for 85% of intervention (N=278) vs. 50% of control (N=374) patients (OR 6.2, p<0.001), and treatment action was received by 83% of intervention vs. 73% of control patients who screened positive (OR 1.8 p=0.13). After adjusting for intervention, site and number of follow-up visits, intervention patients were more likely to be screened (OR 4.8, p<0.001) and to receive a treatment action if screened positive (OR 2.45, p=0.05). Analyses of temporal trends in non-study sites revealed no trend toward general increase in PSD detection or treatment. Conclusions: Automated depression screening in primary and specialty care can improve detection and treatment of PSD.

Original languageEnglish
Pages (from-to)852-857
Number of pages6
JournalJournal of General Internal Medicine
Volume26
Issue number8
DOIs
StatePublished - Aug 2011

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Stroke
Veterans
Primary Health Care
Therapeutics
Ambulatory Care
Neurology
Electronic Health Records
Survivors
Outpatients
Control Groups
Mortality

Keywords

  • computerized reminders
  • depression
  • quality improvement
  • stroke

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Pre-post evaluation of automated reminders may improve detection and management of post-stroke depression. / Williams, Linda; Ofner, Susan; Yu, Zhangsheng; Beyth, Rebecca J.; Plue, Laurie; Damush, Teresa.

In: Journal of General Internal Medicine, Vol. 26, No. 8, 08.2011, p. 852-857.

Research output: Contribution to journalArticle

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abstract = "Background: Post-stroke depression (PSD) occurs in at least one-third of stroke survivors, is associated with worse functional outcomes and increased mortality, and is frequently underdiagnosed and undertreated. Objective: To evaluate the effectiveness of an electronic medical record-based system intervention to improve the proportion of veterans screened and treated for PSD. Design: Quasi-experimental study comparing PSD screening and treatment among veterans receiving post-stroke outpatient care one year prior to the intervention (the control group) to those receiving outpatient care during the intervention period (the intervention group); contemporaneous data from non-study sites included to assess temporal trends in depression diagnosis and treatment. Participants: Veterans hospitalized for ischemic stroke and/or receiving primary care (PC) or neurology outpatient follow-up within six months post-stroke at two (Veterans Affairs) VA Medical Centers. Interventions: We formed clinical improvement teams at both sites. Teams developed PSD screening and treatment reminders and designed tailored implementation strategies for reminder use in PC and neurology clinics. Main Measures: Proportion screened for PSD within 6 months post-stroke; proportion screening positive for PSD who received an appropriate treatment action within 6 months post-stroke. Key Results: In unadjusted analyses, PSD screening was performed within 6 months for 85{\%} of intervention (N=278) vs. 50{\%} of control (N=374) patients (OR 6.2, p<0.001), and treatment action was received by 83{\%} of intervention vs. 73{\%} of control patients who screened positive (OR 1.8 p=0.13). After adjusting for intervention, site and number of follow-up visits, intervention patients were more likely to be screened (OR 4.8, p<0.001) and to receive a treatment action if screened positive (OR 2.45, p=0.05). Analyses of temporal trends in non-study sites revealed no trend toward general increase in PSD detection or treatment. Conclusions: Automated depression screening in primary and specialty care can improve detection and treatment of PSD.",
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N2 - Background: Post-stroke depression (PSD) occurs in at least one-third of stroke survivors, is associated with worse functional outcomes and increased mortality, and is frequently underdiagnosed and undertreated. Objective: To evaluate the effectiveness of an electronic medical record-based system intervention to improve the proportion of veterans screened and treated for PSD. Design: Quasi-experimental study comparing PSD screening and treatment among veterans receiving post-stroke outpatient care one year prior to the intervention (the control group) to those receiving outpatient care during the intervention period (the intervention group); contemporaneous data from non-study sites included to assess temporal trends in depression diagnosis and treatment. Participants: Veterans hospitalized for ischemic stroke and/or receiving primary care (PC) or neurology outpatient follow-up within six months post-stroke at two (Veterans Affairs) VA Medical Centers. Interventions: We formed clinical improvement teams at both sites. Teams developed PSD screening and treatment reminders and designed tailored implementation strategies for reminder use in PC and neurology clinics. Main Measures: Proportion screened for PSD within 6 months post-stroke; proportion screening positive for PSD who received an appropriate treatment action within 6 months post-stroke. Key Results: In unadjusted analyses, PSD screening was performed within 6 months for 85% of intervention (N=278) vs. 50% of control (N=374) patients (OR 6.2, p<0.001), and treatment action was received by 83% of intervention vs. 73% of control patients who screened positive (OR 1.8 p=0.13). After adjusting for intervention, site and number of follow-up visits, intervention patients were more likely to be screened (OR 4.8, p<0.001) and to receive a treatment action if screened positive (OR 2.45, p=0.05). Analyses of temporal trends in non-study sites revealed no trend toward general increase in PSD detection or treatment. Conclusions: Automated depression screening in primary and specialty care can improve detection and treatment of PSD.

AB - Background: Post-stroke depression (PSD) occurs in at least one-third of stroke survivors, is associated with worse functional outcomes and increased mortality, and is frequently underdiagnosed and undertreated. Objective: To evaluate the effectiveness of an electronic medical record-based system intervention to improve the proportion of veterans screened and treated for PSD. Design: Quasi-experimental study comparing PSD screening and treatment among veterans receiving post-stroke outpatient care one year prior to the intervention (the control group) to those receiving outpatient care during the intervention period (the intervention group); contemporaneous data from non-study sites included to assess temporal trends in depression diagnosis and treatment. Participants: Veterans hospitalized for ischemic stroke and/or receiving primary care (PC) or neurology outpatient follow-up within six months post-stroke at two (Veterans Affairs) VA Medical Centers. Interventions: We formed clinical improvement teams at both sites. Teams developed PSD screening and treatment reminders and designed tailored implementation strategies for reminder use in PC and neurology clinics. Main Measures: Proportion screened for PSD within 6 months post-stroke; proportion screening positive for PSD who received an appropriate treatment action within 6 months post-stroke. Key Results: In unadjusted analyses, PSD screening was performed within 6 months for 85% of intervention (N=278) vs. 50% of control (N=374) patients (OR 6.2, p<0.001), and treatment action was received by 83% of intervention vs. 73% of control patients who screened positive (OR 1.8 p=0.13). After adjusting for intervention, site and number of follow-up visits, intervention patients were more likely to be screened (OR 4.8, p<0.001) and to receive a treatment action if screened positive (OR 2.45, p=0.05). Analyses of temporal trends in non-study sites revealed no trend toward general increase in PSD detection or treatment. Conclusions: Automated depression screening in primary and specialty care can improve detection and treatment of PSD.

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