Improving Postpartum Depression Screening Rates Using a Quality Improvement Framework in a Community-based Academic Primary Care Clinic.

Abstract

Introduction: Maternal postpartum depression (PPD) is the most common diagnosis during the postpartum period, with a higher incidence in underserved populations. Though PPD often goes undiagnosed, prompt diagnosis has a positive impact on several measures of children's health and development, as well as maternal health. To increase routine screening per American Academy of Pediatrics recommendations, we implemented a multipronged quality improvement (QI) initiative centered around a newborn coordinator embedded in our primary care clinic.

Methods: A multidisciplinary team implemented a QI initiative in a community-based academic primary care clinic. We used the plan-do-study-act method and other QI tools to improve our processes and p-type control charts to monitor improvements. The interventions centered on workflow changes and staff education with aims to increase our PPD screening rates to 75%, maintain appropriate referral rates for parents with positive PPD screeners above 90%, and ensure no disparity in rates of screening regardless of race/ethnicity, language, and insurance status.

Results: PPD screening rates for all well child care visits from birth to age 6 months increased from a mean of 16 % at baseline to 72%. Additionally, we maintained a referral rate for positive PPD screens above 90%. Our health equity analysis did not demonstrate any disparity in our screening rates.

Conclusions: Applying a combination of education and process workflow changes can successfully increase screening rates for PPD in a community-based academic primary care clinic.