Date of Award

Fall 2025

Project Type

Clinical Doctorate

College or School

CHHS

Department

Nursing

Degree Name

Other

First Advisor

Cathleen Colleran

Abstract

Background: Depression is highly common among U.S. veterans, surpassing civilian rates. Measurement-Based Care (MBC), including the Patient Health Questionnaire-9 (PHQ-9), facilitates systematic symptom monitoring and treatment enhancement. At Manchester VA Medical Center (VAMC), PHQ-9 completion in primary care was low (18.93% in May 2025) due to workflow inefficiencies, provider workload, and dependence on Mental Health Service Line (MHSL) referrals.

Local Problem: Underutilization of the PHQ-9 in primary care hampers early detection and effective treatment of depression among veterans.

Methods: Four primary care teams received training on using the Behavioral Health Laboratory (BHL) software, which facilitates pre-visit electronic completion of the PHQ-9. Implementation was assessed over two 30-day Plan–Do–Study–Act (PDSA) cycles. The primary outcome was PHQ-9 completion rate, while workflow efficiency and staff perceptions were measured as balancing indicators. Data were collected from the electronic Quality Measurement (eQM) system, and team debriefs offered qualitative feedback.

Results: PHQ-9 completion increased to 32.37% in Cycle 1 and 32.45% in Cycle 2, reflecting relative increases of 71.0% and 71.4% from baseline. Although consent requirements limited automation, provider education and workflow reinforcement enhanced adherence. Cost-benefit analysis projected annual savings of $220,521 and a 200% return on investment.

Conclusions: Despite regulatory barriers to full electronic screening, targeted education, workflow redesign, and interprofessional collaboration substantially improved MBC integration. Future efforts should incorporate electronic consent features and broaden digital MBC use to boost efficiency, accessibility, and quality of veteran depression care.

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