Depression Screening: A Quality Improvement Initiative to Increase Identification and Treatment in Primary Care

Depression is a widespread and debilitating condition that frequently goes unrecognized and untreated in primary care settings. Although national guidelines recommend routine screening for adults, inconsistent workflows, limited staff education, and lack of standardized follow-up often prevent timely diagnosis and treatment. This quality improvement project evaluated the implementation of a standardized depression screening and treatment protocol using the Patient Health Questionnaire-9 in a suburban primary care practice in North Carolina.Guided by the Iowa Model of Evidence-Based Practice, the project used a mixed-methods design with a 30-day pre-implementation period followed by three four-week implementation cycles. The intervention included staff and provider education, routine depression screening during eligible annual wellness visits, standardized documentation, and a treatment pathway for positive screens, including suicide risk assessment when indicated. Process, outcome, and balancing measures were collected through chart review, daily audits, and anonymous staff and provider surveys.Baseline depression screening was 0% across 108 eligible visits. During implementation, 150 of 312 eligible patients completed the screening tool, resulting in an overall screening rate of 48%. Two patients screened positive for depression. No measurable increase was observed in behavioral health referrals, antidepressant initiation, or follow-up scheduling during the implementation period. Survey findings showed improved staff and provider knowledge, confidence, and awareness of clinic workflow related to depression screening. Major barriers included staff turnover, short staffing, workflow variability, and limited electronic health record functionality.This project demonstrated that implementing a standardized depression screening protocol in primary care is feasible and can improve screening rates. Continued staff education, workflow reinforcement, and electronic health record support may improve sustainability and strengthen treatment follow-through.