Evaluating Clinical Decision Supports to Improve Adolescent Depression Screening and Management in Pediatric Primary Care

OBJECTIVE: To examine how depression screening rates changed after implementation of electronic health record (EHR) clinical decision support tools and medical assistant (MA)-led depression screening at an outpatient pediatric practice. METHODS: We assessed changes in depression screening rates at an urban academic pediatric clinic between September 2016 and December 2020 using interrupted time series analysis. During this time, we implemented 1) EHR clinical decision support tools for depression screening and management (November 2017) and 2) training of MAs to screen for depression (July 2019). RESULTS: Over the study period, 3963 patients received care in the pediatric clinic. Their mean age was 14.9 years (standard deviation, 2.6) and about half were female (n = 2011, 51%). The majority were Black/African American (n = 2852, 72%) and had private insurance (n = 2860, 72%). Depression screening rates increased from 3% to > 80%. Preintervention, depression screening rates were not increasing (0.9% per month, 95% confidence interval [CI]: -0.3% to 2.1%; P = .15). After implementing EHR clinical decision support tools, there was a 15.6% (95% CI: 2.5%-28.6%, P = .02) increase in the screening rate. Also, MA-led screening was associated with a 24.6% (95% CI: 9.9%-39.2%, P = .002) screening rate increase. CONCLUSION: This study demonstrates that EHR clinical decision support tools and MA-led screening are likely to increase adolescent depression screening and management in pediatric clinics.