Date of Conferral
8-11-2026
Date of Award
August 2026
Degree
Doctor of Nursing Practice (DNP)
School
Nursing
Advisor
Tracy Andrews
Abstract
Depression is a leading cause of disability worldwide and is associated with significant impairment, delayed treatment, and increased suicide risk when not appropriately identified and managed. In an outpatient behavioral health setting, review of de-identified electronic health record (EHR) data identified inconsistent completion of the Patient Health Questionnaire-9 (PHQ-9) following positive Patient Health Questionnaire-2 (PHQ-2) screenings, resulting in incomplete depression assessment and missed opportunities for timely intervention. This Doctor of Nursing Practice (DNP) project evaluated whether implementation of a standardized PHQ-2 to PHQ-9 workflow improved PHQ-9 completion rates among adult outpatients with positive PHQ-2 screenings. The organization change process included baseline EHR review, stakeholder engagement, workflow redesign, staff education, and weekly monitoring over a four-week implementation period. Outcome evaluation used descriptive statistics to compare baseline and implementation PHQ-9 completion rates. Average PHQ-9 completion increased from 37.4% during the pre-implementation period to 89.2% during implementation, with completion reaching 97.6% by Week 4. The standardized workflow improved adherence to evidence-based depression screening practices without requiring additional personnel or specialized equipment. Continued workflow integration, leadership support, routine EHR audits, and ongoing staff education are recommended to sustain improvements. This project demonstrates that standardized, evidence-based workflows can strengthen depression screening practices, improve consistency in clinical decision-making, and support earlier identification and treatment of depressive symptoms. The project has implications for improving patient safety, promoting equitable access to behavioral health services, and supporting sustainable quality improvement in outpatient behavioral health settings.
Recommended Citation
Pieterson, Diana, "Organization Change Process Evaluation Improving PHQ-9 Completion Following Positive PHQ-2 Screenings in an Outpatient Behavioral Health Setting" (2026). Walden Dissertations and Doctoral Studies. 20591.
https://scholarworks.waldenu.edu/dissertations/20591
