Session number: 1041
Abstract title: Predictors of Screening for Depression in a National Sample
Author(s):
PM Peloso - Department of Internal Medicine, College of Medicine, University of Iowa Health Care and Iowa City VAMC
C Carney-Doebbeling - Department of Psychiatry, University of Iowa Health Care
TE Vaughn - Department of Health Management and Policy, University of Iowa College of Public Health
BJ BootsMiller - Program in Health Services Research, Iowa City VAMC and Department of Internal Medicine, University of Iowa College of Medicine
KF Welke - Division of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics and College of Medicine
E Letuchy - Program in Health Services Research, Iowa City VAMC and Department of Internal Medicine, University of Iowa College of Medicine
C Franciscus - Program in Health Services Research, Iowa City VAMC and Department of Internal Medicine, University of Iowa College of Medicine
RF Woolson - Department of Biostatistics, University of Iowa College of Public Health
BN Doebbeling - Program in Health Services Research, Iowa City VAMC, University of Iowa College of Medicine and College of Public Health
Objectives: To determine factors associated with primary care provider screening for depression in patients attending Veterans Affairs Medical Centers (VAMCs).
Methods: The 1998 and 1999 External Peer Review Program (EPRP) assessed chart audit data for depression screening in a stratified national sample of VAMC outpatients. 53 247 charts from 139 VAMCs in 1998 and 74 327 charts from 136 VAMCs in 1999 were reviewed. The proportion of patients in need of screening based on guidelines, that were screened, was calculated for each facility. Patient population characteristics were obtained from the Veterans Satisfaction Survey and hospital characteristics from the AHA Annual Survey. Macro-organizational characteristics were grouped based on an existing conceptual framework: clinical emphasis, organizational capacity, tasks contingencies, professionalism, and urbanicity. Logistic regression examined the association between depression screening and patient and macro-organizational characteristics. Multivarate models within each related group and a final multivariate model were created.
Results: Both patient characteristics and macro-organizational factors were associated with screening in bivariate analyses. Intermediate models organized around the macro-organizational characteristics had moderate discrimination (C-statistics 0.67-0.71) and calibration, Hosmer-Lemeshow (HL) goodness of fit, p<0.0001). Macro-organizational variables positively associated with screening in the final multivariate model were teaching hospital status, residency program accreditation, delivery of specialized services, metropolitan statistical area, and the numbers of FTEs in personnel, physicians, and nurses. Patient variables negatively associated were age, number of medical conditions, and male gender. Positive associations were year of audit, number of non-emergency outpatient visits, organizational resources, and proportion of Black or Hispanic patients. This model had adequate discrimination and calibration (C–statistic 0.73, HL goodness of fit=261.2, p-value <0.0001).
Conclusions: Patient and macro-organizational factors are associated with screening for depression in VAMCs. Addressing both levels of factors may be important for successful implementation of screening programs.
Impact statement: Identifying patient factors and organizational factors associated with screening for depression may lead to appropriate strategies to overcome barriers to routine screening.