Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Holly DiLeo


Juan Carlos Garza


The purpose of this QI project was to improve provider adherence to the Institute for Clinical Systems Improvement (ICSI) Guidelines for Adult Depression in Primary Care to enhance the screening, diagnosis, treatment, and management of adult major depressive disorder (MDD). MDD is a widespread, disabling, and treatable psychiatric disorder that is primarily treated and managed by primary care providers (PCPs). Untreated depression is prone to become chronic and can lead to pain, suffering, disability, increased morbidity and mortality, and premature death, with serious repercussions for the individual and society. Universal and routine screening in primary care for depression in adults, in combination with adequate systems of support, is recommended by ICSI guidelines and has been found to be a cornerstone in the management of MDD. Despite this, depression remains underrecognized, underdiagnosed, and undertreated in primary care. The project objectives aimed at aligning the clinic with ICSI’s guidelines to increase screening for depression, routine assessment for the severity of symptoms, referrals to behavioral health specialists (BHS), and minimize suicide risk. An MDD protocol was developed and all adult patients were universally and routinely screened for depression using PHQ-2 and/or PHQ-9 over an 8-week period. Project interventions were successful at initiating change toward improving provider adherence to ICSI guidelines. Screening rates for depression, routine assessment rate for the severity of symptoms, provider adherence rate to the suicide protocol, and the referral rate to a BHS increased from pre-intervention to post-intervention