Building a SW program in a private hem/onc practice: Using the PHQ-9 as a starting point.

266 Background: Hematology/oncology patients historically have high need for social work support. Community practices lack the structure and financial support of hospital practices, often hindering the growth of social work programs. PHQ-9 is a 9-question multipurpose tool for depression screening, diagnosing, monitoring and intervening. This project assessed using the PHQ-9 as a central focus to build a SW program: staff education, EHR automaticity improvement, and enhancement of patient navigation to improve PHQ-9 compliance and patient interventions. Methods: In a multi-office Hem/Onc practice, patients complete the PHQ-9 self-assessment tool, data is entered by MAs, and MD completes an action item according to score. Interventions, which began 1/1/22, included having patients complete the PHQ-9 via a PRO application before visit, interfacing of PRO application with EHR (MA adds score to treatment plan), educating MAs importance of mental health monitoring in health care setting, generating new workflow for MA to send EHR message to SW and notify MD if high score obtained, rapid cycle review of data with MDs, and building out of SW department to accept referrals. Our primary endpoint was % of PHQ-9s completed of those scheduled (every six months). Secondary endpoint was total number of patients internally referred for SW services since 4/1/22 (when psychotherapy services became available). Results: From 7/1/21-12/31/21 (before implementation), of 22,492 visits, 72% had a PHQ-9 reported (with no ongoing monitoring or intervention). From 1/1/22-5/31/22, 88% of 18,655 visits had a PHQ-9 reported. 1,114 patients had a score of 10 or greater on the PHQ-9 between 1/1/22-5/31/22, and of those patients, 100% were assessed for social work intervention. 724 patients were offered referral for mental health services externally; 390 patients have been recommended for internal SW referral (72 have registered for psychotherapy to begin 7/1/22). Conclusions: Our results illustrate the ability to achieve engagement of a SW program in a private practice setting over a limited time by using the PHQ-9 as a primary focus. Education of all staff involved in the process is paramount and will be emphasized when rolling out future components of the SW program: support groups, educational lecture series, and other concrete services.