{"doi":"10.1017/cts.2025.74","title":"Implementing electronic health record-based anxiety and depression screening in an epilepsy clinic: Theory-based implementation strategy and pre-post quantitative outcomes using Reach, Effectiveness, Adoption, Implementation, and Maintenance","abstract":"Abstract Introduction: Anxiety and depression in epilepsy are common and impactful. Screening with validated measures at every epilepsy visit is a quality measure, yet screening remains limited due to time constraints. Methods: This study aimed to develop an implementation strategy for anxiety and depression screening at an epilepsy center and evaluate it in a pre-post design with RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Guided by the Capability, Opportunity, Motivation-Behavior behavior change wheel framework, the strategy incorporated electronic health record tools and support staff activation of electronic screeners during visit check-in. Outcomes were evaluated over five months post-implementation and compared with two 3-month pre-implementation timeframes. Results: Post-implementation, 29.2% of 943 visits met the anxiety and depression screening quality measure, a significant increase from 12.6% immediately pre-implementation (p < 0.0001) and 6.28% before any screening interventions (p < 0.0001). Patients who completed electronic screeners post-implementation were younger than non-completers (mean 39.3 vs. 43.4 years, p = 0.001) and more likely to be white than other race/ethnicity categories (p = 0.002). There was substantial variability in screening rates among clinic staff (0–80% for support staff, 10.1–55.3% for providers), with higher screening among neurology support staff than temporary staff. Only 0.23% of post-implementation visits had screeners initiated but left incomplete. A shift to virtual visits during COVID-19 complicated Maintenance. Conclusions: This framework-based implementation strategy effectively increased screening rates by epilepsy specialists, though challenges remain, including variability across clinic team members and lower reach among older and non-white patients. This study describes a feasible strategy for epilepsy centers to use for improved performance on an American Academy of Neurology quality measure (depression and anxiety screening for patients with epilepsy).","journal":"Journal of Clinical and Translational Science","year":2025,"id":536106,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9429,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":453164,"name":"Halley B. Alexander","orcid":"0000-0002-1785-1763","position":1,"is_corresponding":false},{"id":430541,"name":"Sabina B. Gesell","orcid":"0000-0002-1997-9816","position":2,"is_corresponding":false},{"id":410220,"name":"Mingyu Wan","orcid":null,"position":3,"is_corresponding":false},{"id":408562,"name":"Kelly Conner","orcid":"0009-0008-7036-0593","position":4,"is_corresponding":false},{"id":408561,"name":"Cormac A. O’Donovan","orcid":"0000-0001-9912-8116","position":5,"is_corresponding":false},{"id":229611,"name":"Jane Boggs","orcid":null,"position":6,"is_corresponding":false},{"id":1420952,"name":"Christian Robles","orcid":null,"position":7,"is_corresponding":false},{"id":727069,"name":"Maria Sam","orcid":"0009-0007-1798-8157","position":8,"is_corresponding":false},{"id":1297584,"name":"Jerryl Christopher","orcid":null,"position":9,"is_corresponding":false},{"id":394815,"name":"Christina Marini","orcid":"0000-0002-5514-0858","position":10,"is_corresponding":false},{"id":71309,"name":"Beverly M. Snively","orcid":"0000-0001-5276-2611","position":11,"is_corresponding":false},{"id":408556,"name":"Heidi M. Munger Clary","orcid":"0000-0002-9889-8351","position":0,"is_corresponding":true}],"reference_count":1,"raw_metadata":null,"created_at":"2026-07-19T02:52:00.885532Z","pmid":"40529000","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}