postpartum depression screening€¦ · background: postpartum depression ppd: first peak in 1. st....
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Postpartum Depression Screening (PPD)
A Resident Quality Improvement Project Children’s Hospital University of Illinois (CHUI)
Vibhash Kumar, MD, Amina Rafique, MD Nayf Edrees, MD, and Amanda Osta, MD
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Disclosure
• No conflict of interest to disclose
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What We Accomplished
67%
PPD
Scr
eeni
ng R
ate
2009 2011
<1%
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CHUI General Pediatrics Clinics
• University affiliated program
• One continuity site
• 38 residents
• 8 general Pediatrics faculty
• On site social worker
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Background: Postpartum Depression
PPD: First peak in 1st 2 months, 2nd peak at 6 months*
PPD screening: significant impact on mother’s and infant’s health outcomes.
Postpartum depression screening is a CMS Quality measure
*Chaudron et al ;Peds in review; 2003. **Sheeder, et al, PEDIATRICS ; 2009
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Edinburgh Postnatal Depression Scale
• Well validated*
• 10 self reportable items with Score 0 to 30
• Special attention to item 10
• >11 points suggests depression
• Available in Spanish and English
• Takes 5 minutes to fill and <1 minute to review
* Chaudron et al , Pediatrics. 2004;113:551– 8.
*Heneghan et al, Pediatrics. 2000;106:1367–73
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Quality Improvement Project
• Aim Statement (goal): Year 1: To screen 50% of mothers of infant <2
months for PPD Year 2: To screen 75% of mothers of infant
<6 months
• Project Outline PPD Screening by residents and attendings in
WCC Data gathering: Administrative billing
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Screening and referral process
Screening of Mothers in COC clinic
Referral of very high risk mothers to Women’s Psychiatry
Regular follow-up of high risk mothers by social worker
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PDSA Cycle
DO STUDY
ACT PLAN
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PDSA Cycle 1
Plan: Increase PPD
screening for mothers of infants <2 months
to 50%
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PDSA Cycle 1
PLAN
* Baseline < 1%
* Educate residents
DO *Baseline data collection *Educate residents *Screening performed
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PDSA Cycle 1
Plan: Increase the PPD screening at any WCC <2 months
to 50%
DO * Baseline < 1%
* Educate residents
Study *Data Collection using billing sheet *Analysis of PPD screening *Feedback
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PDSA Cycle 1
Act: Additional Education
needed
Plan: Increase the PPD screening at any WCC <2 months
to 50%
DO * Baseline < 1%
* Educate residents *Screening performed
Study
*Data Collection and analysis.
*Analysis of PPD screening by individual providers.
Act: *New interventions *Additional Education of residents
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Stepwise Interventions
• Educating attendings and residents • Baseline data collection
• Involve on site social worker • Involve Healthy Steps coordinator
• Flyers for the mothers • Flyers for the residents
• Changes in EMR • Involvement of Medical Assistants
1
• Integration of Edinburgh PPD Scale in Bright Futures patient education folder
Cycle %Screening
45% 2
1
50%
67%
57%
21%
3
4
5
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Total number of mothers screened
0
200
400
600
800
1000
1200
1400
1600
2009 2010 2011
N=1458
N=42
N=901
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Challenges Faced
• Additional training
• Appropriate place to document of PPD screening score: mom’s vs infant’s chart
• Communication with providers of high risk mothers
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Limitations
• Inadequate follow-up of high risk mothers
• Five PDSA Cycles performed over 2 year period
• Data was collected by counting billing sheets
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Future Directions
• Institute assessment for PPD in High Risk Clinic.
• Ensure tracking and adequate follow up for high risk mothers
• Communicate with providers of high risk mothers
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Special Thanks
Residents Attendings Alicia Idler, MD Rachel Caskey, MD Kalyan Parashette,MD Alan Schwartz, PhD Olga Ochoa, MD Michelle Barnes, MD Asad Bandealy, MD Sidhuja Harshavardhana, MD
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Thank you
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0
10
20
30
40
50
2009 2010
2011
Number of high risk mothers referred
N=0
N=16
N=46
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PDSA Cycle 5 data
66%
76%
62%
88%
38%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Monday Tuesday Wednesday Thursday Friday
% of Mothers screen by a particular COC Group