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Budget Development
The implementation of systematic depression screening using the PHQ-9 in primary care settings requires careful financial planning to ensure project sustainability and organisational buy-in. This budget will cover the direct and indirect expenses of the quality improvement project in improving depression screening among the older individuals aged 65 years and above at the primary care clinic. Since this is a quality improvement project, the practice site will supply most of the resources required to implement the project, such as the time of the existing staff, electronic health record infrastructure, and physical space. The overall cost of the project will be estimated at 825, which is a small investment with high returns in terms of patient outcomes, quality measurements, and cost-reduction related to undiagnosed depression. Studies have shown that unmanaged depression among older adults leads to higher expenditures on healthcare as they visit the emergency department at least once annually, get readmitted to the hospital at least once a year, and acquire complications associated with uncontrolled chronic illnesses per year (Li et al., 2023). The budget will be dedicated to the resources needed to support the completion of the project goals of 80% screening completion and 90% of the positive screens connected to the follow-up care to meet the project aims and objectives of the 80% and 90% screening completion rates and positive screen linkage to follow-up care, respectively.
Direct Costs
Direct costs are costs that can be directly linked to the introduction and implementation of the PHQ-9 screening protocol. These expenses are minimal since the clinic will offer the available resources, such as staff time during regular working hours, availability of the electronic health record system, and conference room space that will be used to conduct training. The direct expenses are restricted to the consumable materials and supplies required to screen and educate the patients. A study by Blackstone et al. (2022) showed that a regular training regimen among nursing personnel led to an increased screening adherence rate and confidence in depression assessment. Training will be administered in regular staff meetings and will use the available clinic time, and no extra personnel expenses will be involved, as the DNP student has already invested his or her time, which is offered as a part of the academic program.
Indirect Costs
Indirect costs are overhead costs, administrative costs that sustain the implementation of the project, but are not directly related to particular deliverables. In this quality improvement project, most of the indirect costs are in the form of in-kind contributions by the clinic, such as facilities, utilities, existing equipment, and administrative infrastructure. The low indirect costs indicate the expenditure on project dissemination, preparation of the final report, and a small contingency fund to cater to the unexpected needs that may arise in the course of the eight-week implementation timeframe. The indirect costs are allocated in accordance with the traditional institutional standards of quality improvement efforts and are reflective of the costs that are not previously incurred by the existing clinic operations. It has also added a contingency fund calculated at 10% of direct costs to deal with the possible unexpected costs or changes in the implementation plan based on the feedback in PDSA cycles (Taylor et al., 2014).
Cost-Benefit Analysis
The cost-benefit analysis indicates that there is a significant financial and clinical benefit of introducing systematic PHQ-9 screening of depression among older adults. Depression is a critical societal burden, with about 15% of adults aged 65 and above having cases of depression, and only half of the cases are detected during regular primary healthcare checkups (Reynolds et al., 2022). Diagnosis and treatment of depression in the elderly is related to higher costs of health care because of the escalated number of patients who visit the emergency department, require hospital readmission and poor management of chronic illnesses. Li et al. (2023) provided an estimate of 3-5,000 dollars per patient annually as the additional costs of undiagnosed depression to healthcare. This quality improvement initiative, which will incur a minimum investment of $825, is a remarkably low-cost strategy for handling this huge clinical and financial burden.
The clinic is a primary care clinic with a population of about 450 patients, who are aged 65 years and above. According to the present rates of baseline screening, which are based on the 40 per cent figure, there are only 180 patients receiving screening annually. With the screening completion rate set to 80 per cent, 180 more patients will get systematic screening for depression every year. This augmented screening will find about 27 more cases of depression each year, not previously diagnosed, using the prevalence estimate of 15% of depression in older adults. When properly treated, the conservative estimates indicate that a depression will save healthcare expenditures by about $2,500 a year per patient because of fewer hospitalisations, fewer ED visits, and the fact that comorbid chronic conditions will be better treated (Li et al., 2023). According to the findings, treating 27 more patients with depression in a year would be approximately 67,500/year to save the cost.
The rates of depression screening also improve, leading to improvement in the performance of quality metrics applicable to value-based payment models. Numerous health insurance policies, such as Medicare Advantage plans, have been updated to include depression screening as a quality measure in Healthcare Effectiveness Data and Information Set (HEDIS) measures and Medicare Star Rating. By increasing the rate of depression screening compliance (40 to 80 per cent), it would be estimated that the increment in revenue (estimated to be 15,000-25,000) would be achieved by raising the quality incentive payment and value-based reimbursement systems.
The calculation of the ROI reflects tremendous financial feasibility. The initial investment of $825 and the estimated benefits of saving costs of $67,500, and the expected quality incentive revenue of about 20,000 yearly, give an estimated total of the first year benefit of $87,500. This will give a net benefit of 86675 and a net ROI of 10506. The low cost of the project investment is recouped in a few days after it has been implemented, and the current costs are restricted to the cost of consumable screening supplies, which cost around 200 to 300 per annum.
This not only brings about intangible benefits that are not measurable in monetary terms. The positive outcome observed with respect to quality of life among older adults and their families is because higher rates of improved patient outcomes are achieved by cases of early detection and treatment of depression. The systematised screening practice prevents practice variation and provides consistent and evidence-based care for all providers. Employee education improves patient-centred care and mental health assessment clinical competencies. Moreover, the risk of undiagnosing cases and the liability risk are minimised, and the clinical practice guidelines and regulatory requirements are adhered to through systematic screening of depression.
The infrastructure that is created in this project, such as electronic health record templates, staff training programs, standard workflow processes, and data collection systems, has a permanent organisational asset. The low financial demand is a characteristic of the joint collaboration of the DNP student, clinic leadership, and staff in enhancing patient care using available resources.
To conclude, depression screening using systematic PHQ-9 among elderly patients will be an ideal investment with remarkable financial payoffs and significant clinical advantages. This is because of the low investment of $825, which translates to projected annual benefits of more than 87, 000 leading to a high payback of more than $10,000. The presented quality improvement project shows that significant changes in patient care and clinical outcomes are possible with the help of well-considered initiatives that utilise the already available resources and do not demand significant financial support.
References
Blackstone, E. R., Greiner, M. V., & Manian, N. (2022). Implementing standardised screening for depression in primary care. Journal of Primary Care & Community Health, 13, 18. https://doi.org/10.1177/21501327221094921
Li, D., Min, S., Guo, X., Liu, B., & Zhang, T. (2023). The association between chronic disease and depression in middle-aged and older adults: The moderating effect of health insurance and health service quality. Frontiers in Public Health, 11, Article 935969. https://doi.org/10.3389/fpubh.2023.935969
Reynolds, C. F., Jeste, D. V., Sachdev, P. S., & Blazer, D. G. (2022). Mental health care for older adults: Recent advances and new directions in clinical practice and research. World Psychiatry, 21(3), 336363. https://doi.org/10.1002/wps.20996
Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290298. https://doi.org/10.1136/bmjqs-2013-001862