Date of Award

Spring 2018

Project Type

Clinical Doctorate

College or School




Program or Major


Degree Name


First Advisor

Dayle Sharp


Depression is one of the leading causes of disease and disability, often found in patients with long-term chronic physical conditions such as diabetes. Collaborative care, which includes care managers, has shown to improve depression outcomes in patients; usual care has been shown to be inadequate. This quality improvement project screened patients with diabetes for depression. Patients with an elevated depression screening score were provided care management support and rescreened every two weeks to evaluate depression symptoms. A small cohort of patients from two rural health clinics participated in the improvement project. The practices noted improvement in depression screening; patients who participated and received care management services had an overall improvement in Patient Health Questionnaire-9 (PHQ-9) scores and glycated hemoglobin (A1c) rates over the project period. The practice findings indicated that focusing on improved systems for rural health clinic patients with diabetes and depression may impact health outcomes, however, additional work needs to be done to determine sustainability in rural health clinics beyond the quality improvement project period. The quality improvement project limitations included study design and size.