The Journal of the Arkansas Medical Society Issue 1 Vol 115 | Page 12

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EDITORIAL PANEL
Chad T. Rodgers, MD, FAAP; Elena M. Davis, MD, MPH;
Michael Moody, MD; J. Gary Wheeler, MD, MPS
Increase Screening of Depression
and Alcohol Use Disorders
BY CAITLIN FENERTY MOORE,
MPH, CPHQ
N
early 20 percent of Medicare
beneficiaries live with at least
one mental health or substance
use condition, according to the Nation-
al Council for Behavioral Health and
the Institute of Medicine. However, less
than 40 percent of these older adults
receive treatment. 1 In the Medicare
population, depression has a higher in-
patient readmission rate than all other
conditions, except heart failure. 2
A major concern of the medical
community is the prevalence of
undetected or misdiagnosed alcohol
use disorders (AUD) and depression.
As the population of adults over age
65 grows, identification through
screening, within primary care
practices, is the first step to help
improve the lives of Medicare
beneficiaries with these conditions.
Alcohol is the most commonly
abused substance and can cause
serious medical complications. 3 AUDs
coupled with depression can be even
more life-threatening among older
adults. These mental conditions often
go undetected when physical ail-
ments are being treated. 4 Older adults
are also less likely to seek mental
health care because of a stigma about
mental health treatment.
A MULTI-STATE APPROACH
The TMF Quality Innovation Network
Quality Improvement Organization
(QIN-QIO), partnering with AFMC to
serve Arkansas, is addressing these
concerns through its Behavioral Health
project, with a grant awarded by the
Centers for Medicare & Medicaid Ser-
vices (CMS). Community coalitions of
primary care clinicians, inpatient psychi-
atric facilities (IPFs), hospitals, special-
ists, partners and other stakeholders
throughout Arkansas, Missouri, Okla-
homa, Puerto Rico and Texas, are work-
ing to increase screening for depression
and AUDs in primary care settings and
reduce the 30-day readmission rate for
patients discharged from IPFs. They
also want to increase the number of
Medicare beneficiaries who have an
outpatient visit with a behavioral health
provider after an IPF hospitalization.
Since the project began in June
2015, more than 1,000 participating
practices have joined the Behavioral
Health Learning and Action Network
(BHLAN). These providers are working
to reach a goal of screening 75 per-
cent of their Medicare patients annu-
ally for depression and AUD. Since the
beginning of the project participants
in Arkansas have screened 77,764
beneficiaries for AUD and 107,866
beneficiaries for depression, through
mid-2017, according to CMS’ reports.
SHARING BEST PRACTICES
AFMC’s quality improvement
specialists consistently seek to iden-
tify high performers in the behavioral
health work. Each quarter that new
data is available, the AFMC team com-
pletes individual scorecards for each
participating practice. The scorecard
helps them work effectively with the fa-
cilities to review their rates, rate trends
and goals. When a team identifies a
particularly high-performing practice,
they give the practice a chance to
participate in a success story to share
achievements, tips and best practices
for other providers in the BHLAN.
One of Arkansas’ high-performing
providers is ARcare, with 38 practice
sites in Arkansas. ARcare began
focusing on improved depression
screening by developing standing
orders for nurses to perform Patient
Health Questionnaire-2 (PHQ-2) and
PHQ-9 testing and creating reminder
alerts in the electronic health record
(EHR). ARcare created monthly
scorecards and shared them with
all clinical staff. Within four months,
screenings increased from less than
5 percent to more than 90 percent.
Later, they added AUD screening and
a plan for addressing positive screens.
ARcare now averages more than 90
percent screening rates for both AUD
and depression.
THE ARKANSAS FOUNDATION FOR MEDICAL CARE, INC. (AFMC) WORKS COLLABORATIVELY WITH PROVIDERS, COMMUNITY GROUPS AND OTHER STAKEHOLDERS TO PROMOTE THE QUALITY
OF CARE IN ARKANSAS THROUGH EDUCATION AND EVALUATION. FOR MORE INFORMATION ABOUT AFMC QUALITY IMPROVEMENT PROJECTS, CALL 1-877-375-5700. • JULY 2018
12 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
VOLUME 115