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Abstract Details

Implementation of Electronic Health Record-based Anxiety and Depression Screening in an Epilepsy Clinic: Description of Theory-based Implementation Strategy and Quantitative Outcomes Using RE-AIM
Epilepsy/Clinical Neurophysiology (EEG)
P10 - Poster Session 10 (11:45 AM-12:45 PM)
1-006
To describe an implementation strategy for anxiety and depression screening at epilepsy clinic visits and perform an outcome assessment using components of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework.
Anxiety and depression in epilepsy are common, yet under-detected and undertreated. The 好色先生 quality measures include screening for them at every visit. However, a survey of epilepsy specialists indicated a top barrier is limited time to conduct screening.
A strategy for anxiety and depression screening was developed using the Capability, Opportunity, Motivation (COM-B) behavior change framework. The strategy was implemented, incorporating electronic health record (EHR)-based tools and certified medical assistant (CMA) initiation of electronic screeners at the end of check-in. Outcomes were evaluated over a five-month period using components of the RE-AIM framework. Due to COVID-19 and the subsequent transition to virtual visits near the implementation period, evaluation of Maintenance was complicated. 
During the five-month timeframe there were 1097 visits scheduled and 876 visits completed. Among the completed visits, quality measure for anxiety and depression screening was met in 30.9% of visits, compared to 6.2% of consecutive visits in a three-month timeframe prior to any screening implementation interventions. Patients who completed screening were younger than those who did not (mean age 39.4 years (SD 16.0) vs. 43.6 (SD 18.1), p=0.002). Differences by gender or race/ethnicity were not statistically significant. There was substantial provider and CMA-level variability in screening (0-80% for CMAs and 11.5-55.9% for providers), though CMAs and clinic team members who attended education sessions had higher visit screening than temporary staff. Only 0.5% of electronic screeners initiated were not fully completed. 
This framework-based anxiety and depression screening strategy increased quality measure attainment by epilepsy specialists, but with considerable variability across clinic team members and lower reach among older patients. 
Authors/Disclosures
Paneeni Lohana, DO
PRESENTER 		Dr. Lohana has nothing to disclose.
Beverly Snively The institution of Beverly Snively has received research support from National Institutes of Health. The institution of Beverly Snively has received research support from Duke Endowment. The institution of Beverly Snively has received research support from Department of Defense. The institution of Beverly Snively has received research support from PCORI.
Jerryl Christopher (University of North Carolina at Chapel Hill) No disclosure on file
Sabina Gesell No disclosure on file
Heidi Munger Clary, MD, MPH (Wake Forest University School of Medicine) Dr. Munger Clary has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Xenon. Dr. Munger Clary has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Prova 好色先生. Dr. Munger Clary has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Epilepsia Open. Dr. Munger Clary has stock in HCA Healthcare. Dr. Munger Clary has stock in Eli Lilly. Dr. Munger Clary has stock in Procter and Gamble. Dr. Munger Clary has stock in CVS. Dr. Munger Clary has stock in Johnson and Johnson. Dr. Munger Clary has stock in Novartis. Dr. Munger Clary has stock in Danahauer. The institution of Dr. Munger Clary has received research support from National Institute of Health. The institution of Dr. Munger Clary has received research support from Suzanne Marcus Collins Foundation. The institution of Dr. Munger Clary has received research support from Eysz, Inc. The institution of Dr. Munger Clary has received research support from Department of Defense. The institution of Dr. Munger Clary has received research support from Duke Endowment. Dr. Munger Clary has received personal compensation in the range of $500-$4,999 for serving as a speaker, Psychiatry Commission member with International League Against Epilepsy. Dr. Munger Clary has received personal compensation in the range of $0-$499 for serving as a Faculty with J. Kiffin Penry Epilepsy 好色先生 Programs. Dr. Munger Clary has a non-compensated relationship as a advisor, potential site PI with Liva Nova that is relevant to AAN interests or activities.