367 - Improving rates of Maternal Depression screening at well-child appointments using a Quality Improvement framework

Poster Number: 367
Publication Number: 367.1726

Background: Maternal PostPartum Depression (PPD) is the most common mental health diagnosis in women during the first year postpartum, yet a majority of affected mothers are undiagnosed. Routine screening has been recommended, yet it is not universal. Children born to mothers who experience PPD have a higher incidence of adverse health outcomes and prompt diagnosis in mothers has been shown to have a positive impact on several measures of children’s health and development.

Objective: We aimed to increase rates of PPD screening in a hospital-affiliated primary care clinic serving primarily an under-resourced pediatric population where 85% of the patients have public insurance and 49% do not identify English as their preferred language. The screening was carried out using the Edinburgh Postpartum Depression Screening (EPDS) tool at all well child visits (WCV) up to 6 months. We also sought to increase rates of referrals of mothers with a positive EPDS screen. Lastly, we aimed to ensure rates of screening were identical for mothers with different characteristics including race/ethnicity, language, and insurance type.

Design/Methods: We developed a multi-disciplinary team centered around a Newborn Coordinator/Population Manager and initiated a multi-pronged Quality Improvement initiative. PDD screening and referral rates were determined through monthly chart review of all completed WCV for patients < 7 months and tracked using statistical process control charts. We also conducted a health equity analysis by examining the proportion of completed WCV with a complete EPDS screen by using a combination of relative difference and chi-square analyses (p value < 0.01). The initiative started in May 2022 with the creation of a process map and was followed by several PDSA cycles, including 1) the systematic standardization of visit packets to include the EPDS, 2) medical provider education emphasizing importance of screening, and 3) the creation of a tracking and communication system for missed patients to ensure screening was completed at the next visit.

Results: The PPD screening rate increased from a baseline of 18% pre intervention to 45% post intervention, a 27% change. In parallel, referrals to appropriate resources for mothers who had a positive EPDS score rose from 25% to 100%. The health equity analysis did not uncover any disparities in screening or referrals based on family characteristics, including race, language and insurance status.

Conclusion(s): We successfully demonstrated that rates of screening for PDD and appropriate referrals could be increased in an equitable manner using a Quality Improvement framework.


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