519 - Bridging the Gap Between Diabetes and the Mental Health Crisis: A Quality Improvement Initiative
Friday, April 22, 2022
6:15 PM – 8:45 PM US MT
Poster Number: 519 Publication Number: 519.107
Elizabeth Vargas, Connecticut Children's Medical Center, Manchester, CT, United States; Cem Demirci, Connecticut Children's Medical Center, Farmington, CT, United States; Stacey H. Reicher, CT Children's Medical Center, West Hartford, CT, United States
Pediatric Resident Physician Connecticut Children's Manchester, Connecticut, United States
Background: The mental health crisis among American youth was further exposed by the COVID-19 pandemic. At baseline, anxiety and depression are more prevalent among people with diabetes. Early identification and initiation of mental health treatment may minimize the negative impact on quality of life, diabetes management, and long-term health outcomes.
Objective: To implement an annual mental health screen for adolescents with diabetes at a pediatric endocrinology clinic and an action protocol for providers to refer appropriate mental health resources in-real-time. Goal of screening 50% of eligible patients and using the action protocol for screen-positive patients 75% of the time.
Design/Methods: A practice-level quality improvement initiative was implemented in a large multi-disciplinary pediatric endocrinology clinic in Farmington, Connecticut. A “stress questionnaire” (SQ) was given to patients 12-18 years old diagnosed for at least 6 weeks with type 1 or type 2 diabetes (T1D, T2D) who presented for a routine office visit. The SQ contained validated screening tools, GAD-7 and PHQ-9, used to identify patients at risk of anxiety and depression/suicide, respectively. In addition, it included questions regarding the presence of diabetes distress due to fear of hypoglycemia in patients or caregivers, and needle-phobia. Patients with a positive screen were recommended mental health resources based on an action protocol. Resources included: social work referral, establishment with a mental health provider, information on mental health risk, and mobile crisis. Outcome measures included the rate of eligible patients screened annually and action protocol use in screen-positive patients.
Results: Data over a 4-month QI study period show that 58% of eligible patients were screened and the action protocol was used in 96% of screen-positive patients. Among all patients screened, 14% were positive for anxiety, 15% depression, and 8% suicide. Patients positive for anxiety had a 71% rate of concurrent depression. Fear of hypoglycemia was reported in 50% of anxiety-positive patients.Conclusion(s): Implementing a SQ as part of a routine pediatric endocrinology visit, and a provider action plan for mental health resources in real-time are successful modalities for identifying and initiating appropriate resources for adolescents with diabetes and concurrent anxiety, depression, and/or suicide. Elizabeth Vargas CV 2022Elizabeth Vargas_CV_2022_PAS.pdf