2010-P: Implementation of Universal Depression Screening in an Urban Pediatric Endocrinology Clinic

Introduction and Objective: Adolescents with diabetes have a higher risk for depression, which adversely impacts disease management. Despite guidelines endorsing routine depression screening, implementation remains inconsistent in pediatric specialty clinics. This study aimed to determine if a multi-phase, EHR-integrated intervention increased adolescent depression screening rates in an urban pediatric endocrinology clinic. Methods: A quality improvement study was performed at the University of Chicago pediatric endocrinology clinic among patients aged 12-17. Depression screening implementation was phased: initial EHR integration (Jan 2018-Sep 2022), Pilot: physician champion patients only (Oct-Dec 2022), Intervention 1: all patients with annual screening (Jan-Dec 2023), and Intervention 2: all patients at every visit (Jan 2024-Jun 2025). PHQ-2/9 was administered. Interrupted time series analyzed monthly screening rates; multivariable logistic regression assessed differences in screening by sociodemographic. Results: Overall, among 2,996 eligible visits, 1,131 (37.8%) were screened. Pre-intervention, average monthly rate was 0.2%. Following the Pilot, screening increased by immediately by 19.2% (p=.03), with a significant monthly increase (12.7%; p=.03). Screening decreased by 5.9% (p=.64) after Intervention 1, with a monthly decrease of 15.3% compared to pre-intervention 1 (p<0.01). After Intervention 2, screening increased by 33.6% (p<.001), with a monthly increase of 3.3% compared to the prior trend (p<0.001). PHQ-2 positivity was 13.1%; 66.0% showed moderate-to-severe PHQ-9 symptoms. Black (aOR=0.71, p=0.001) and Asian (aOR=0.43, p=0.008) patients were less likely to be screened than White patients. Conclusion: EHR decision support with continuous quality improvement markedly improved adolescent depression screening rates in an urban pediatric endocrinology clinic. This Intervention is feasible but gaps in equity persist, highlighting the need for targeted outreach and ongoing monitoring. Disclosure D. Correa Bucio: None. J.R. Winer: None. M. Zhu: None. N. Laiteerapong: Research Support; Current; Novo Nordisk. K. O'Sullivan: None.