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

Disclosure

• No conflict of interest to disclose

What We Accomplished

67%

PPD

Scr

eeni

ng R

ate

2009 2011

<1%

CHUI General Pediatrics Clinics

• University affiliated program

• One continuity site

• 38 residents

• 8 general Pediatrics faculty

• On site social worker

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

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

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

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

PDSA Cycle

DO STUDY

ACT PLAN

PDSA Cycle 1

Plan: Increase PPD

screening for mothers of infants <2 months

to 50%

PDSA Cycle 1

PLAN

* Baseline < 1%

* Educate residents

DO *Baseline data collection *Educate residents *Screening performed

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

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

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

Total number of mothers screened

0

200

400

600

800

1000

1200

1400

1600

2009 2010 2011

N=1458

N=42

N=901

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

Limitations

• Inadequate follow-up of high risk mothers

• Five PDSA Cycles performed over 2 year period

• Data was collected by counting billing sheets

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

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

Thank you

0

10

20

30

40

50

2009 2010

2011

Number of high risk mothers referred

N=0

N=16

N=46

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