NR 583NP Week 8 Depression Registry Proposal Example

Informatics Proposal: A Depression Registry and a Four-Week Repeat PHQ-9 Task, Requested From the Quality Committee for a Six-Month Pilot at Two Sites

Student Name

College of Nursing, Chamberlain University

NR 583NP: Informatics for Advanced Nursing Practice

Instructor Name

Month Day, Year

Informatics Proposal: A Depression Registry and a Four-Week Repeat PHQ-9 Task, Requested From the Quality Committee for a Six-Month Pilot at Two Sites

The Ask

I ask the quality committee, at its 18 November 2026 meeting, to approve 60 hours of IT analyst time and 20 hours a week of care coordinator time for six months to build and run a depression registry with a four-week repeat PHQ-9 task at the Linden Avenue and Westgate sites, starting 1 February 2027.

A Problem in the Work, Not a Missing Product

The practice finds depression and then loses track of it. In the second quarter of 2026, 312 adults screened positive on a first PHQ-9. Only 61 of them (20%) had a repeat PHQ-9 within 12 weeks, and only 45% had any contact within 30 days, although 86% had a follow-up plan box checked. Today, the only way to find these patients after the visit is a Thursday list I run by hand, which shows screens from the past week and nothing older. A patient who misses a call drops off the list for good.

The problem is not that the practice lacks registry software. The practice already has the data. What fails is the work after the visit: nobody is assigned to check whether treatment is working, and nothing reminds anyone to.

The Evidence Behind the Problem

Repeating the PHQ-9 during treatment measures change reliably (Löwe et al., 2004), and measurement-based care, in which scores guide changes to treatment, has better outcomes than usual care but is rarely practiced in routine settings (Fortney et al., 2017). Our 20% repeat rate is consistent with that gap.

A Change Specific Enough to Build

The build has four parts.

First, a registry view in the record listing every adult whose PHQ-9 reached 10 or higher in the past 12 months, with the latest score, its date, the date of the last contact and whether the patient sees the BHC.

Second, a task that appears in the care coordinator's work queue four weeks after any PHQ-9 at or above 10, asking for a repeat PHQ-9 by phone, portal or visit.

Third, a portal questionnaire sent automatically with the task for patients active on the portal.

Fourth, retiring the signing reminder for the follow-up plan box for patients already on the registry, which NPs dismiss up to several times a week for the same patient.

The Evidence Behind the Remedy

The registry and the repeat task are parts of collaborative care. The IMPACT trial randomized 1,801 adults aged 60 and over in 18 primary care clinics; those assigned a depression care manager who tracked symptoms had better depression outcomes at 12 months than those given usual care (Unützer et al., 2002). A Cochrane review found collaborative care improved depression outcomes in the short and medium term (Archer et al., 2012). This proposal builds only the tracking part; it does not add psychiatric case review, which would cost more.

Alternatives, Including Doing Nothing

Doing nothing keeps the 20% repeat rate and leaves the Thursday list as the only safety net.

A spreadsheet registry, which I tried for six weeks in the spring, failed because it had to be updated by hand and fell behind within three weeks.

The record vendor's full collaborative care module includes psychiatric review and billing support, but its license is roughly $28,000 a year, and the practice has no consulting psychiatrist yet.

The proposed build uses tools already in the record and can be expanded into the vendor module later.

Cost in Dollars and in Minutes

IT analyst time: 60 hours at about $55 an hour, about $3,300, plus four hours a month of support.

Care coordinator time: 20 hours a week for six months, about $26,000 at current salary and benefits. About 8 of those hours already go to the Thursday list, so the added cost is about 12 hours a week, about $15,600.

NP time: no added keystrokes. Retiring the repeated reminder removes clicks; I estimate one to three a week per NP.

BHC time: likely to rise if more patients are reached, which the BHC has agreed to report monthly.

Measures of Effect, Not Use

The main outcome is how many patients on the registry have a repeat PHQ-9 within 12 weeks, from a baseline of 20%. The secondary measure is the share with a 50% drop in PHQ-9 score at six months, which is the usual definition of response. Registry views opened and tasks closed will be tracked, but they measure use, not effect, and will not be reported as success.

How the Work Will Run Day to Day

Each morning the care coordinator opens the task queue, calls patients due for a repeat PHQ-9 who have not answered the portal questionnaire and records each score in the flowsheet. Scores that have not improved by at least five points after eight weeks are sent to the patient's NP with a note asking whether treatment should change, which is the step that makes the registry more than a list. Patients who cannot be reached after three attempts get a letter and stay on the registry. The BHC reviews the registry with the care coordinator for 30 minutes every Friday, starting with patients whose scores have risen since the last call.

Risks

The task queue could grow faster than one coordinator can work it; the scope rule in the next section handles that. NPs may not act on the notes about unchanged scores, so I will count how many notes lead to a treatment change. Patients may find repeated calls intrusive, so each call offers the portal or the next visit instead.

When to Abandon It

At the three-month review, if the repeat PHQ-9 rate at the two pilot sites is below 35%, the committee should stop the pilot and keep only the registry view. If care coordinator time exceeds 25 hours a week, the scope should shrink to patients with scores of 15 or more. If the rate reaches 40% or more at six months, I will return with a proposal to extend to all four sites.

Decision Requested

Approve the 60 analyst hours and the care coordinator time, decline both or approve a smaller pilot at Westgate alone. Any of the three can be decided at the 18 November meeting.

References

Archer, J., Bower, P., Gilbody, S., Lovell, K., Richards, D., Gask, L., Dickens, C., & Coventry, P. (2012). Collaborative care for depression and anxiety problems. Cochrane Database of Systematic Reviews, 2012(10), CD006525. https://doi.org/10.1002/14651858.CD006525.pub2

Fortney, J. C., Unützer, J., Wrenn, G., Pyne, J. M., Smith, G. R., Schoenbaum, M., & Harbin, H. T. (2017). A tipping point for measurement-based care. Psychiatric Services, 68(2), 179-188. https://doi.org/10.1176/appi.ps.201500439

Löwe, B., Unützer, J., Callahan, C. M., Perkins, A. J., & Kroenke, K. (2004). Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Medical Care, 42(12), 1194-1201. https://doi.org/10.1097/00005650-200412000-00006

Unützer, J., Katon, W., Callahan, C. M., Williams, J. W., Jr., Hunkeler, E., Harpole, L., Hoffing, M., Della Penna, R. D., Noël, P. H., Lin, E. H. B., Areán, P. A., Hegel, M. T., Tang, L., Belin, T. R., Oishi, S., & Langston, C. (2002). Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. JAMA, 288(22), 2836-2845. https://doi.org/10.1001/jama.288.22.2836