• Melissa I Franco, Erin M Staab, Mengqi Zhu, Alexandra Knitter, Wen Wan, Robert Gibbons, Lisa Vinci, Sachin Shah, Daniel Yohanna, Nancy Beckman, and Neda Laiteerapong.
• Department of Medicine, University of Chicago, Chicago, IL, USA.
• J Gen Intern Med. 2023 Mar 1; 38 (4): 857864857-864.

BackgroundA population health approach to depression screening using patient portals may be a promising strategy to proactively engage and identify patients with depression.ObjectiveTo determine whether a population health approach to depression screening is more effective than screening during clinic appointments alone for identifying patients with depression.DesignA pragmatic clinical trial at an adult outpatient internal medicine clinic at an urban, academic, tertiary care center.PatientsEligible patients (n = 2713) were adults due for depression screening with active portal accounts. Patients with documented depression or bipolar disorder and those who had been screened in the year prior to the study were excluded.InterventionPatients were randomly assigned to usual (n = 1372) or population healthcare (n = 1341). For usual care, patients were screened by medical assistants during clinic appointments. Population healthcare patients were sent letters through the portal inviting them to fill out an online screener regardless of whether they had a scheduled appointment. The same screening tool, the Computerized Adaptive Test for Mental Health (CAT-MH™), was used for clinic- and portal-based screening.Main MeasuresThe primary outcome was the depression screening rate.Key ResultsThe depression screening rate in the population healthcare arm was higher than that in the usual care arm (43% (n = 578) vs. 33% (n = 459), p < 0.0001). The rate of positive screens was also higher in the population healthcare arm compared to that in the usual care (10% (n = 58) vs. 4% (n = 17), p < 0.001).ConclusionFindings suggest depression screening via a portal as part of a population health approach can increase screening and case identification, compared to usual care.Trial RegistrationClinicalTrials.gov Identifier: NCT03832283.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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