Researchers performed a retrospective analysis of EHR data from 24 Federally Qualified Health Centers that assessed effectiveness and accuracy of the PHQ-2 (depression screening) and GAD-2 (anxiety screening) tools from 2019 to 2021. In this high-risk population, only 9% of PHQ-2 and GAD-2 screening tests were positive for depression or anxiety. This was a significantly lower rate of depression and anxiety than what was expected given the published literature on screening outcomes. Even among patients who were newly diagnosed with depression or anxiety within the previous 30 days, the screening tests were only positive in about 57% of patients. One possible explanation that the authors propose is that when patients are asked to respond to repetitive screening questions to meet clinics' performance metrics, it may have unintended consequences, including a decrease in accuracy of the patient-reported information. It may also not be delivering the intended value in a real-world setting and could risk distracting clinical effort from other high-value activities.
What We Know: Primary care visits often start with numerous standardized intake screening questions tied to performance metrics and incorporated into electronic health records (EHRs). Prioritizing repetition of intake screening questionnaires at primary care visits may have unintended consequences such as administrative burden, provision of low-value care, and reduced clinical capacity to deliver other high-value services.
What This Study Adds: Study findings indicate potentially compromised accuracy of anxiety and depression screeners when their implementation is driven by a need to meet performance metrics and they are repetitive and embedded into EHRs and visit workflows. The authors underscore the importance of not confusing metrics with objectives ("surrogation") and that similar wisdom could be useful in health care given the implementation of care processes like depression and anxiety screening to meet a performance metric may inadvertently lead to reduced accuracy and low-value care.
Reduced Accuracy of Intake Screening Questionnaires Tied to Quality Metrics
Jodi Simon, DrPH, MS, et al
AllianceChicago, Chicago, Illinois
Pre-embargo article link (Link expires at 5 p.m. EDT Sept. 25, 2023)
