008 - Improving Maternal Postpartum Depression Screening Rate in a Resident Continuity Clinic

Publication Number: 8.5147

Myoung Choi, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Camila Pereiras Rodriguez, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Mohamad Baraa Alebaji, SUNY Downstate - - Brooklyn, NY - 450 clarkson avenueBrooklyn, NY 11203UNITED STATES - Brooklyn, NY, Brooklyn, NY, United States; Hal Sitt, NYC Health+Hospitals/Kings County, Brooklyn, NY, United States; Paridhi Anand, NYC Health+Hospitals/Kings County, Brooklyn, NY, United States

Background: Postpartum depression (PPD) is a common obstetric complication in the US, which adversely affects the critical early period of infant brain development. A well-established system to implement PPD screening at the 1-, 2-, 4-, and 6-month well child visit can effectively detect PPD to be treated and buffer the stress on the infant. However, despite previous recommendations, less than half of pediatricians screened mothers for maternal depression in the 2013 periodic survey of AAP members.

Objective: To increase the maternal PPD screening rate in a resident continuity practice to 75% in three months.

Design/Methods: We conducted a survey on the perception and practice of pediatric residents on PPD. Based on the survey results, education sessions on importance of PPD screening with comprehensive resources for positive PPD screening took place. As a main intervention, we added the Patient Health Questionnaire-9 (PHQ-9) score and a direct link to access the PHQ-9 questionnaire on the note template to ensure quick and easy review. The baseline data were collected for 6 months prior to the intervention. The intervention was based on PDSA cycle. For each cycle, the number of patients, who had 1-, 2-, 4-, and 6-month well child visit and the number of patients, who had 1-, 2-, 4-, and 6-month well child visit with completed maternal PHQ-9 were retrieved from the EMR.

Results: The PPD screening rate in the resident continuity clinic was 11% at baseline. Once the intervention was in effect, we reassessed the screening rate for every PDSA cycle. The rates were 34%, 31%, and 58% for cycle 1, 2, and 3, respectively. The number continued to rise to 77% for cycle 4, which was above our initial goal.

Conclusion(s): At our institution, mothers, who come for 1-, 2-, 4-, and 6-month well child visit, receive a tablet with PHQ-9 questionnaire connected to the electronic medical records (EMR) system before seeing the clinicians. However, multiple factors interfered, and the screening rate was low. Frequently, incomplete screenings were missed by providers due to the time-consuming nature of reviewing and conducting the screening. With our intervention, we witnessed a significant improvement in the screening rate from 11% to 77%. This simple modification of the documentation system can be easily adapted to various EMR and remind the clinicians of the screening. This also saves clinicians' invaluable time when conducting the screening themselves. With improved screening rate, we will detect the PPD early enough to improve the outcomes of mothers with PPD by providing timely evaluation and management of PPD.

Maternal Postpartum Depression Screening Rate
PPD Screening Run Chart.pdf

Maternal Postpartum Depression Screening Rate
PPD Screening Run Chart.pdf