PROMIS Tool Implementation to Improve Depression Screening: A Quality Improvement Project in a COVID Recovery Clinic

Background: Long COVID is a heterogenous condition with a wide range of symptoms that persist or develop after acute COVID-19 infection. Depression has been identified as a common primary symptom of Long COVID. In the United States, approximately 10 to greater than 30% of adults with Long COVID experience comorbid depressive symptoms. Individuals with Long COVID depression are at increased risk of long-term psychiatric illness, substance-use disorder, and suicide. Vague clinical presentation and symptom overlap make it challenging to detect signs and symptoms of depression in Long COVID. Routine depression screening improves early recognition of symptoms and treatment outcomes. The United States Preventive Services Task Force (USPSTF) has long recommended routine depression screening for adults in outpatient settings. The National Institute for Health and Care Excellence (NICE) COVID-19 rapid guideline for managing Long COVID also recommends routine depression screening to improve outcomes for patients with Long COVID. Objective: To implement the Patient-Reported Outcomes Measurement Information System Scale for Depression (PROMIS Depression scale) for clinicians to assess depressive symptoms in adult patients at a COVID recovery clinic within six weeks. Methods: This quality improvement project was focused on implementing routine depression screening using the PROMIS Depression scale at a COVID-19 recovery clinic located in the southeastern United States. The Plan-Do-Study-Act (PDSA) Cycles guided the implementation of this practice change and was used to evaluate adherence and identify barriers to using the PROMIS Depression scale for depression screening. The change was implemented in three PDSA Cycles over six weeks. The total number of completed screens was tracked and recorded each week. Debriefing questions were utilized after each PDSA Cycle to identify barriers and generate solutions to optimize the effectiveness and sustainability of the practice change. Results: Adherence to the administration of the PROMIS Depression scale for depression screening decreased over the PDSA Cycles during the six-week implementation period. A total of 30 screens were completed and 45 patients were seen for in-office visits by the end of PDSA Cycle 3. The average rate of adherence for all PDSA Cycles was 74.4%. The rate of adherence for PDSA Cycle 1 was 100%, which decreased in PDSA Cycle 2 (73.3%) and in PDSA Cycle 3 (50%). Analysis of implementation barriers revealed common themes related to staffing, time constraints, and competing responsibilities. Conclusions: The implementation of the PROMIS Depression scale was not a sustainable practice change due to resource constraints in the context of increased demands for Long COVID services at the implementation site. Future endeavors should consider implementing the PROMIS Depression scale in primary care settings for patients with Long COVID or other chronic conditions.