Lucy J Puryear1, Yen H Nong2, Nancy P Correa3, Katherine Cox4, Christopher S Greeley5. 1. Obstetrics and Gynecology, Menninger Department of Psychiatry, Baylor College of Medicine, 6651 Main Street, Houston, TX, 77030, USA. lpuryear@bcm.edu. 2. Public Health Pediatrics, Baylor College of Medicine, 6621 Fannin Street, MC A2275, Houston, TX, 77030, USA. 3. Public Health Pediatrics, Texas Children's Hospital, 6621 Fannin Street MC A2275, Houston, TX, 77030, USA. 4. Women's Services, Texas Children's Hospital Pavilion for Women, 6651 Main Street, Houston, TX, 77030, USA. 5. Vice-Chair for Community Health, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, MC A2275, Houston, TX, 77030, USA.
Abstract
PURPOSE: We report on a successful quality improvement project designed to increase access to perinatal mental health services through universal screening for postpartum depression (PPD) and facilitating referrals for evaluation and treatment, at a multi-site, integrated system of pediatric and obstetric practices in Houston, Texas. DESCRIPTION: Obstetric practices administered screenings twice during pregnancy and at 6 weeks postpartum. Pediatric practices screened women at the 2 week and 2, 4, and 6-month well-baby visit. Women with a score of 10 or higher on the Edinburgh Postnatal Depression Scale (EPDS) or women that reported thoughts of self-harm were offered a referral to a mental health provider. Data on screening and referrals were collected from the electronic medical record. RESULTS: A total of 102,906 screens for PPD were completed between May 2014 and July 2018. Of those, 6487 (6.3%) screened positive. The total number of women referred to treatment were 3893 (3.8%). Of referred women 2172 (55.8%) completed an appointment with a mental health provider within 60 days of referral. Rates of completed appointments varied by the level of integration of the mental health provider and referring physician: women referred by pediatrics in a Level 1 coordinated system completed 20.0% of referrals; obstetrics Level 4 co-located system, 76.6%; and obstetrics Level 5 integrated model, 82.7%. CONCLUSION: This project demonstrated that with planning, systems review and trained staff, PPD screening can be integrated into obstetric and pediatric practices and high screening and referral rates can be achieved.
PURPOSE: We report on a successful quality improvement project designed to increase access to perinatal mental health services through universal screening for postpartum depression (PPD) and facilitating referrals for evaluation and treatment, at a multi-site, integrated system of pediatric and obstetric practices in Houston, Texas. DESCRIPTION: Obstetric practices administered screenings twice during pregnancy and at 6 weeks postpartum. Pediatric practices screened women at the 2 week and 2, 4, and 6-month well-baby visit. Women with a score of 10 or higher on the Edinburgh Postnatal Depression Scale (EPDS) or women that reported thoughts of self-harm were offered a referral to a mental health provider. Data on screening and referrals were collected from the electronic medical record. RESULTS: A total of 102,906 screens for PPD were completed between May 2014 and July 2018. Of those, 6487 (6.3%) screened positive. The total number of women referred to treatment were 3893 (3.8%). Of referred women 2172 (55.8%) completed an appointment with a mental health provider within 60 days of referral. Rates of completed appointments varied by the level of integration of the mental health provider and referring physician: women referred by pediatrics in a Level 1 coordinated system completed 20.0% of referrals; obstetrics Level 4 co-located system, 76.6%; and obstetrics Level 5 integrated model, 82.7%. CONCLUSION: This project demonstrated that with planning, systems review and trained staff, PPD screening can be integrated into obstetric and pediatric practices and high screening and referral rates can be achieved.
Authors: Elizabeth O'Connor; Rebecca C Rossom; Michelle Henninger; Holly C Groom; Brittany U Burda Journal: JAMA Date: 2016-01-26 Impact factor: 56.272
Authors: Nancy Byatt; Leonard L Levin; Douglas Ziedonis; Tiffany A Moore Simas; Jeroan Allison Journal: Obstet Gynecol Date: 2015-11 Impact factor: 7.661
Authors: Eyal Shemesh; Brianna J Lewis; Melissa Rubes; Michael A Ambrose; Meghan K Cahill; Christopher Knight; Scott H Sicherer; Rachel A Annunziato Journal: J Pediatr Date: 2015-10-21 Impact factor: 4.406