Methods for improving efficiency in quality measurement: the example of pain screening

Use of Newly Covered Versus Established Preventive Care Screening: Comparison of Depression and Smoking Screening

Pay-for-value initiatives include both depression and smoking screening. Evaluating how patterns of care differ for an established screening (smoking) versus newer screening (depression) can help programs better implement these measures. Our objective is to evaluate (1) patterns of smoking and depression screening and (2) how patient factors affect screening patterns. We analyzed retrospectively collected electronic health record data from 4,763 Medicare-patients in 34 primary care practices between 2010 and 2012. The relationship between multimorbidity, history of stroke, and having depression on receipt of screening was evaluated. The outcome variables were no screening, smoking screening only, or concurrent smoking and depression screening. Fifty percent of patients were screened for smoking at every visit and never screened for depression (n = 2,378). Twelve percent of patients with ≥five visits received both depression and smoking-status screens on each of their first five visits. Screening patterns varied significantly across sites. For example, one site screened approximately 87% of patients for both depression and smoking-status at every visit. Another site screened 93% of patients for smoking during the first visit but did not conduct depression screening. Programs considering initiating new screenings should evaluate the clinic-specific workflow of successful screenings and integrate new screenings using the same strategy.