Date of Award

Fall 2026

Abstract

Background. Depression and anxiety are common among adults with type 2 diabetes and obesity, yet one-time intake screening may not identify symptoms that emerge or change during treatment. Local Problem. Within a telehealth obesity care program, PHQ-9 and GAD-7 screening occurred at intake, but no standardized reassessment process existed. Methods. A single Plan-Do-Study-Act cycle evaluated electronic PHQ-9 and GAD-7 reassessment among adults with type 2 diabetes and obesity. The primary outcome was reassessment completion, with a prespecified feasibility target of at least 20%. Paired symptom changes, clinical and safety triggers, and follow-up were also evaluated. Intervention. A one-time electronic reassessment was distributed to 804 patients with reminder communications and a standardized response-triage protocol. Results. The reassessment was completed by 170 patients (21.1%), exceeding the feasibility target; 169 had verifiable paired data. Baseline symptoms were predominantly minimal for depression (80.2%) and anxiety (83.8%). Thirty-four participants (20.1%) had a clinically significant change of at least 5 points in either direction, including 21 (12.4%) with clinically significant worsening. Fourteen of those 21 (66.7%) remained below 10 on both reassessment instruments. Three patients (1.8%) endorsed PHQ-9 Item 9, and all 26 patients meeting follow-up criteria received outreach. Conclusions. Structured electronic reassessment was feasible and identified clinically important individual changes not apparent from cohort-level averages or cross-sectional severity thresholds alone. Findings support subsequent PDSA testing and development of a sustainable, EHR-integrated reassessment workflow.

Document Type

Clinical Doctorate

First Advisor

Jessica Bacon

Second Advisor

Florencia Halperin

College or School

CHHS

Department or Program

Department of Nursing

Degree Name

Doctor of Nursing Practice

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