Date Approved
4-20-2026
Graduate Degree Type
Dissertation
Degree Name
Nursing (D.N.P.)
Degree Program
College of Nursing
First Advisor
Dr. Dave Vander Ark
Second Advisor
Susan Blackburn
Third Advisor
Dr. Cindy Mendez
Academic Year
2025/2026
Abstract
Background: Primary care clinics can identify the risk of depression. The Patient Health Questionnaire-9 (PHQ-9) is used for this purpose, but variability in provider documentation may limit the ability to track follow-up after positive screenings. Objective: To evaluate provider documentation practices after implementation of a standardized electronic health record (EHR) SmartPhrase for positive PHQ-9 screenings in a primary care clinic. Methods: Guided by the Centers for Disease Control and Prevention program Evaluation Framework, this program evaluation compared documentation practices in July and November 2025 following clarification of workflows and updates to EHR reporting. Quantitative data were obtained through retrospective EHR reports and manual chart review. Measures included adherence to SmartPhrase, documentation of treatment for positive PHQ-9 results, and agreement between EHR reports and manual review. Provider perspectives were explored through surveys and interviews. Results: SmartPhrase adherence increased from 66.7 percent to 77.1 percent. Documentation indicating provider follow-up remained high across both periods. Agreement between EHR reports and manual chart review was perfect (κ = 1.00). Providers identified benefits of screening but noted workflow challenges. Conclusions: Clarification of workflows and improvements to reporting enhanced tracking of provider responses to depression screening. Implications for Nursing: Evaluating documentation workflows may strengthen monitoring of depression screening and support integration of mental health care in primary care
ScholarWorks Citation
Ayers, Douglas Joshua, "Evaluation of PHQ-9 Documentation and Follow-Up Care After Implementation of an EHR SmartPhrase in Primary Care" (2026). Doctoral Dissertations. 80.
https://scholarworks.gvsu.edu/dissertations/80
