Improving mental health screening for patients with inflammatory bowel disease in a gastroenterology clinic: a quality improvement initiative

Abstract

Background: Depression and anxiety occur at higher rates among individuals with inflammatory bowel disease and are associated with increased disease activity, healthcare utilization, and reduced quality of life. Clinical guidelines recommend routine mental health screening in gastroenterology settings; however, implementation remains inconsistent. Local Problem: A needs assessment at a western Montana outpatient gastroenterology clinic identified no standardized depression or anxiety screening process. Chart review demonstrated lower documented rates of these conditions than literature reports, suggesting potential under recognition of psychiatric comorbidities. Methods: This quality improvement project used the Institute for Healthcare Improvement Model and six Plan-Do-Study-Act cycles to implement a mental health screening workflow. Data collected over six weeks included screening completion, documentation adherence, patient education, and primary care referrals. Interventions: After staff education, a standardized workflow incorporated validated screening tools, including the PHQ-9 and GAD-7, electronic documentation templates, patient education, and communication of positive results to primary care providers. Results: Among 845 patients offered screening, 749 completed assessments (88%). Screening identified 136 patients with positive results, including 10 with a documented diagnosis of inflammatory bowel disease (five with Crohn's disease and five with ulcerative colitis). Additionally, 26 patients had no prior documented diagnosis of depression and 21 had no prior documented diagnosis of anxiety. All positive screening results were communicated to patients' primary care providers, and one new referral to primary care was placed. Conclusion: Mental health screening in a gastroenterology clinic was feasible and improved identification of previously unrecognized depression and anxiety.