Key Workflow Components and Tracking



Routine Screenings

To implement measurement-based care, patients are screened in the clinic for depressive symptoms using a Patient Health Questionnaire (PHQ-2/PHQ-9) as a part of the patients’ health maintenance items.

Patients who screen positive on the PHQ-2 are further evaluated with the PHQ-9 to determine whether they meet the criteria for a depressive disorder.

Download the PHQ-2/PHQ-9


Remeasurement Algorithm

The MIDUS Remeasurement Algorithm allows clinicians and treatment team members the ability to quickly identify the next steps to take for patients with different PHQ-9 scores.

Patient remission is the goal of the screening protocol and management recommendations. For patients who remit, MetroHealth continues to re-measure every 6 months for the following year (2 measurements). If the patient remains in remission, the patient moves to annual PHQ-2/9 screenings.

Download the MIDUS Flow Chart


Case Formulation

A systematic approach was developed for providing case consultation for depressed patients with HIV.

History and information obtained from the BHM along with a review of the patient’s chart help formulate a differential diagnosis, evaluate factors that may be contributing to depression, and make treatment recommendations.

Consideration of biological, psychological, or social factors, that are playing a role in presentation is recommended, which can help develop the most effective treatment plan. Often, the treatment plan is adjusted based on new information obtained or lack of response to previous intervention.

Download the MIDUS Case Consultation


Electronic Registry

An electronic registry within the EHR is used to monitor HIV patients. Having the electronic registry in the EHR limits what information can be displayed, but it does provide population health information at a glance. It includes patient demographics, last PHQ9 value, and date as well as whether the patient is currently active in collaborative care, being monitored while in early remission or receiving annual screening.

The registry allows for rapid identification of patients who are due for re-measurement or sorting for patients with the most severe symptoms. It also decreases data entry needs and updates real-time.


Next: Caseload Recommendations