Implementing electronic health record-based anxiety and depression screening in an epilepsy clinic: Theory-based implementation strategy and pre-post quantitative outcomes using Reach, Effectiveness, Adoption, Implementation, and Maintenance
Abstract Introduction: Anxiety and depression in epilepsy are common and impactful. Screening with validated measures at every epilepsy visit is a quality measure, yet screening remains limited due to time constraints. Methods: This study aimed to develop an implementation strategy for anxiety a...
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| Format: | Article |
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Cambridge University Press
2025-01-01
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| Series: | Journal of Clinical and Translational Science |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S2059866125000743/type/journal_article |
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| author | Heidi M. Munger Clary Halley B. Alexander Sabina Gesell Mingyu Wan Kelly R. Conner Cormac O’Donovan Jane Boggs Christian Robles Maria Sam Jerryl Christopher Christina Marini Beverly M. Snively |
| author_facet | Heidi M. Munger Clary Halley B. Alexander Sabina Gesell Mingyu Wan Kelly R. Conner Cormac O’Donovan Jane Boggs Christian Robles Maria Sam Jerryl Christopher Christina Marini Beverly M. Snively |
| author_sort | Heidi M. Munger Clary |
| collection | DOAJ |
| description |
Abstract
Introduction:
Anxiety and depression in epilepsy are common and impactful. Screening with validated measures at every epilepsy visit is a quality measure, yet screening remains limited due to time constraints.
Methods:
This study aimed to develop an implementation strategy for anxiety and depression screening at an epilepsy center and evaluate it in a pre-post design with RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Guided by the Capability, Opportunity, Motivation-Behavior behavior change wheel framework, the strategy incorporated electronic health record tools and support staff activation of electronic screeners during visit check-in. Outcomes were evaluated over five months post-implementation and compared with two 3-month pre-implementation timeframes.
Results:
Post-implementation, 29.2% of 943 visits met the anxiety and depression screening quality measure, a significant increase from 12.6% immediately pre-implementation (p < 0.0001) and 6.28% before any screening interventions (p < 0.0001). Patients who completed electronic screeners post-implementation were younger than non-completers (mean 39.3 vs. 43.4 years, p = 0.001) and more likely to be white than other race/ethnicity categories (p = 0.002). There was substantial variability in screening rates among clinic staff (0–80% for support staff, 10.1–55.3% for providers), with higher screening among neurology support staff than temporary staff. Only 0.23% of post-implementation visits had screeners initiated but left incomplete. A shift to virtual visits during COVID-19 complicated Maintenance.
Conclusions:
This framework-based implementation strategy effectively increased screening rates by epilepsy specialists, though challenges remain, including variability across clinic team members and lower reach among older and non-white patients. This study describes a feasible strategy for epilepsy centers to use for improved performance on an American Academy of Neurology quality measure (depression and anxiety screening for patients with epilepsy).
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| format | Article |
| id | doaj-art-c5e0b52199d84be1b2e73d9c7293dbca |
| institution | OA Journals |
| issn | 2059-8661 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Journal of Clinical and Translational Science |
| spelling | doaj-art-c5e0b52199d84be1b2e73d9c7293dbca2025-08-20T02:25:44ZengCambridge University PressJournal of Clinical and Translational Science2059-86612025-01-01910.1017/cts.2025.74Implementing electronic health record-based anxiety and depression screening in an epilepsy clinic: Theory-based implementation strategy and pre-post quantitative outcomes using Reach, Effectiveness, Adoption, Implementation, and MaintenanceHeidi M. Munger Clary0https://orcid.org/0000-0002-9889-8351Halley B. Alexander1Sabina Gesell2https://orcid.org/0000-0002-1997-9816Mingyu Wan3Kelly R. Conner4Cormac O’Donovan5Jane Boggs6Christian Robles7Maria Sam8Jerryl Christopher9Christina Marini10Beverly M. Snively11Department of Neurology, Wake Forest University School of Medicine, USADepartment of Neurology, Wake Forest University School of Medicine, USADepartment of Social Sciences and Health Policy, Wake Forest University School of Medicine, USANeuroscience Graduate Program, Wake Forest University, USADepartment of Neurology, Wake Forest University School of Medicine, USA Department of Physician Assistant Studies, Wake Forest University School of Medicine, USADepartment of Neurology, Wake Forest University School of Medicine, USADepartment of Neurology, Wake Forest University School of Medicine, USADepartment of Neurology, Wake Forest University School of Medicine, USADepartment of Neurology, Wake Forest University School of Medicine, USADepartment of Biostatistics and Data Science, Wake Forest University School of Medicine, USADepartment of Neurology, New York University Grossman School of Medicine, USADepartment of Biostatistics and Data Science, Wake Forest University School of Medicine, USA Abstract Introduction: Anxiety and depression in epilepsy are common and impactful. Screening with validated measures at every epilepsy visit is a quality measure, yet screening remains limited due to time constraints. Methods: This study aimed to develop an implementation strategy for anxiety and depression screening at an epilepsy center and evaluate it in a pre-post design with RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Guided by the Capability, Opportunity, Motivation-Behavior behavior change wheel framework, the strategy incorporated electronic health record tools and support staff activation of electronic screeners during visit check-in. Outcomes were evaluated over five months post-implementation and compared with two 3-month pre-implementation timeframes. Results: Post-implementation, 29.2% of 943 visits met the anxiety and depression screening quality measure, a significant increase from 12.6% immediately pre-implementation (p < 0.0001) and 6.28% before any screening interventions (p < 0.0001). Patients who completed electronic screeners post-implementation were younger than non-completers (mean 39.3 vs. 43.4 years, p = 0.001) and more likely to be white than other race/ethnicity categories (p = 0.002). There was substantial variability in screening rates among clinic staff (0–80% for support staff, 10.1–55.3% for providers), with higher screening among neurology support staff than temporary staff. Only 0.23% of post-implementation visits had screeners initiated but left incomplete. A shift to virtual visits during COVID-19 complicated Maintenance. Conclusions: This framework-based implementation strategy effectively increased screening rates by epilepsy specialists, though challenges remain, including variability across clinic team members and lower reach among older and non-white patients. This study describes a feasible strategy for epilepsy centers to use for improved performance on an American Academy of Neurology quality measure (depression and anxiety screening for patients with epilepsy). https://www.cambridge.org/core/product/identifier/S2059866125000743/type/journal_articlePsychiatric comorbiditymental healthseizuresepilepsy quality measuresquality of life |
| spellingShingle | Heidi M. Munger Clary Halley B. Alexander Sabina Gesell Mingyu Wan Kelly R. Conner Cormac O’Donovan Jane Boggs Christian Robles Maria Sam Jerryl Christopher Christina Marini Beverly M. Snively Implementing electronic health record-based anxiety and depression screening in an epilepsy clinic: Theory-based implementation strategy and pre-post quantitative outcomes using Reach, Effectiveness, Adoption, Implementation, and Maintenance Journal of Clinical and Translational Science Psychiatric comorbidity mental health seizures epilepsy quality measures quality of life |
| title | Implementing electronic health record-based anxiety and depression screening in an epilepsy clinic: Theory-based implementation strategy and pre-post quantitative outcomes using Reach, Effectiveness, Adoption, Implementation, and Maintenance |
| title_full | Implementing electronic health record-based anxiety and depression screening in an epilepsy clinic: Theory-based implementation strategy and pre-post quantitative outcomes using Reach, Effectiveness, Adoption, Implementation, and Maintenance |
| title_fullStr | Implementing electronic health record-based anxiety and depression screening in an epilepsy clinic: Theory-based implementation strategy and pre-post quantitative outcomes using Reach, Effectiveness, Adoption, Implementation, and Maintenance |
| title_full_unstemmed | Implementing electronic health record-based anxiety and depression screening in an epilepsy clinic: Theory-based implementation strategy and pre-post quantitative outcomes using Reach, Effectiveness, Adoption, Implementation, and Maintenance |
| title_short | Implementing electronic health record-based anxiety and depression screening in an epilepsy clinic: Theory-based implementation strategy and pre-post quantitative outcomes using Reach, Effectiveness, Adoption, Implementation, and Maintenance |
| title_sort | implementing electronic health record based anxiety and depression screening in an epilepsy clinic theory based implementation strategy and pre post quantitative outcomes using reach effectiveness adoption implementation and maintenance |
| topic | Psychiatric comorbidity mental health seizures epilepsy quality measures quality of life |
| url | https://www.cambridge.org/core/product/identifier/S2059866125000743/type/journal_article |
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