493 - Comparing Pediatric Anxiety Screening with and without Implementing a Quality Improvement Process in Primary Care

Publication Number: 4484.493

Shengyi Mao, Ohio State University College of Medicine, Columbus, OH, United States; Madison Hyer, Ohio State University College of Medicine, Columbus, OH, United States; Susan Friedman, Ohio State University College of Medicine, Worthington, OH, United States; Nazhat Taj-Schaal, Ohio State University College of Medicine, Lewis Center, OH, United States; Shivam Joshi, Ohio State University, Columbus, OH, United States; Neeraj Tayal, Ohio State University College of Medicine, Columbus, OH, United States; Hannah Parks, Ohio State University College of Medicine, Columbus, OH, United States; Rachael McGuirk, Ohio State University College of Medicine, Columbus, OH, United States; Rachel Gordon, The Ohio State University, Columbus, OH, United States

Background: In 2022, the United States Preventative Services Task Force recommended screening children and adolescents ages 8-18 for anxiety. Early recognition and treatment of anxiety allow for improved health outcomes, reduced functional impairment, and decreased risk of developing more severe or persistent mental health problems. However, the impact of structured quality improvement to increase rates of anxiety screening and the effect on anxiety diagnosis remains unclear.

Objective: This is a retrospective, observational cohort study to compare the effects of a structured clinic-wide implementation of pediatric anxiety screening with a control group where providers implement screening at their discretion.

Design/Methods: This study looked at pediatric anxiety screenings in primary care clinics within a large urban academic medical center in Ohio. We reviewed electronic health record data of preventative visit encounters for patients ages 8-18 between January 1, 2024 and December 31, 2024. Four Internal Medicine-Pediatric clinics used quality improvement processes to implement anxiety screening at all preventative visits (QI group) in the year prior to the measurement period. Nine Family Medicine practices were used as a control group where individual practitioners implemented the new guidelines independently at each provider's discretion. Descriptive statistics and chi-squared tests were used to interpret the data.

Results: A total of 3,747 encounters were analyzed (QI group= 2,273, control group=1,474). The QI group had higher rates of anxiety screening at preventative visits (69.0% in QI group, 34.1% in control group, p< 0.001). Of those screened, 374 (23.8%) were positive in the QI group and 83 (16.5%) were positive in the control group (p < 0.001). In the QI group, 347 (15.3%) had a diagnosis of anxiety on their problem list versus 68 (4.6%) in the control group (p < 0.001). Of patients who screened positive for anxiety, 133 (35.6%) had a diagnosis of anxiety in the QI group and 18 (21.7%) had a diagnosis of anxiety in the control group (p=0.015).

Conclusion(s): Concerted efforts at the practice level improve implementation of anxiety screening in line with clinical guidelines. Implementing universal anxiety screening was associated with double the rate of screening compared to usual practice. More screening is associated with higher rates of anxiety identification and diagnosis, allowing clinicians to intervene and treat anxiety earlier. While recognition is the first step, more studies are needed to see the impact of broad anxiety screening on health outcomes.

Figure 1
Flow diagram of Pediatric Anxiety Screening