759 - Improving Primary Care Office Systems and Clinical Services for Adolescent Mental Health and Substance Use Problems

Publication Number: 759.5384

Varsha Pudi, Robert Larner, M.D., College of Medicine at the University of Vermont, Woodstock, MD, United States; Christine Pellegrino, Vermont Child Health Improvement Program (VCHIP), Burlington, VT, United States; Stanley J. Weinberger, UVM Children's Hospital, Burlington, VT, United States; Rachel Garfield, Vermont Child Health Improvement Program, Burlington, VT, United States; Valerie S. Harder, University of Vermont, Burlington, VT, United States

Background: The U.S. is amidst an adolescent and young adult (AYA) mental health crisis that continues to escalate. Pediatric-serving primary care practices are on the front lines to screen and manage AYA mental health and substance use concerns.

Objective: Assess a quality improvement (QI) learning collaborative to improve office systems for screening and managing AYA patients for mental health and substance use concerns, while monitoring provider burnout.

Design/Methods: Providers and staff participated in a seven-month QI learning collaborative that included a day-long learning session, monthly webinars, and submission of monthly measures on screening with validated tools and management of depression, anxiety, and substance use concerns from 10 AYA health supervision visits. Practices completed a pre and post office systems inventory to assess their office systems’ support of AYA mental health and substance use concerns. Providers completed Abbreviated Maslach Burnout Inventory Forms to self-report burnout over time. We analyzed changes in office systems, clinical measures, and burnout using t-tests and chi-square analyses. We used logistic regressions to examine associations between post-QI office system function and final month clinical measures.

Results: This study involved 990 patients ages 12 to 21 across 18 practices, with 78% located in rural counties statewide. All clinical measures improved (ps < 0.05), and four of five office system categories improved (ps < 0.05) from pre- to post-QI. During this time, there was no change in provider burnout (ps>0.05). By the end of the collaborative, practices with higher functioning recall and reminder systems were more likely to assess anxiety (OR=5.7) and alcohol and drug use (OR=3.7) with a validated tool. Practices with higher functioning systems for substance use screening were more likely to assess alcohol and drug use (OR=23.6) with a validated tool. Practices with higher functioning systems to promote mental health conversations were more likely to assess emotional well-being (OR=4.0).

Conclusion(s): This study found improvements in mental health and substance use screening and office systems following a QI intervention with no change to provider burnout. Also, higher functioning office systems were associated with better clinical support for AYA with mental health and substance use concerns. Focusing on office systems improvement may support primary care providers in managing behavioral health among AYA patients.

Figure 1
Summary of office systems inventory measures self-assessed by practices pre and post learning collaborative.

Figure 2
Summary of results for clinical mental health and substance use prevention management measures.