Depression in Individuals with Chronic Liver Disease: Improving Screening in the Outpatient Setting

Problem Statement: Individuals with chronic conditions such as chronic liver disease experience higher rates of depression, often underdiagnosed and placing high risk demographics in jeopardy of adverse outcomes, including worsening prognosis, decreased quality of life, and increased symptomatology. Purpose: Evidence advocates for routine depression screening within high-risk patient populations. This paper outlines the implementation of a quality improvement initiative aimed at enhancing depression screening at a selected outpatient liver clinic within an extensive hospital system by implementing the PHQ-9 questionnaire during patient clinic visits, where no standardized screening protocol was previously in place. Methods: The Plan-Do-Study-Act cycle guided the implementation of the quality improvement initiative. Participants were recruited from the liver clinic selected within the hospital system identified. Inclusion Criteria: English-speaking patients with chronic liver disease attending the selected outpatient liver clinic within the specified hospital system, male and female patients 18 years and older who can mentally answer the screening questions. The intervention includes the distribution of the PHQ-9 screening questionnaire to participants, discussion of the score with the provider during clinic visits, and referral to follow up with the primary care provider for further evaluation and management of symptoms over a 3-month period. Analysis: Descriptive statistics were used for data measurement Implications for Practice: The implementation of this comprehensive quality improvement initiative presents an opportunity to proactively address the underdiagnosis of depression in individuals with chronic liver disease. By fostering a responsive healthcare environment, the initiative aims to mitigate the impact of depression on overall well-being and enhance the quality of care provided within outpatient liver clinics.