Increasing Postpartum Depression Screening in the Pediatric Setting
Keywords:postpartum depression, depression screening, outpatient pediatrics, PDSA, quality improvement, process improvement
Statement of Significance
Undetected postpartum depression has adverse health effects on both the affected mother and her child. In the context of growing literature supporting universal screening for postpartum depression, this quality improvement project aimed to implement screening within the context of pediatric well child visits. Screening for postpartum depression in the pediatric setting is feasible and can lead to identification of postpartum women in need of further evaluation that might not otherwise garner provider attention. Implementing simultaneous quality improvement processes in two different sites and sharing lessons learned with a broader healthcare network can expedite effective innovation.
Background: Postpartum depression (PPD) affects 10-15% of new mothers. The long-term of untreated PPD on both the mother and child are well documented in the literature. Historically, formal screening has not been a standard part of pediatric visits since the focus of the visit is on the infant as the patient. However, the frequent check-ups throughout the first year of life serve as a reliable touchpoint during which screening can be done, and the American Academy of Pediatrics (AAP) recommends screening in this setting.
Methods: Two clinics simultaneously aimed to improve the usage of the Edinburgh Postpartum Depression Scale as a screening tool for PPD at the 1-month, 2-month, 4-month, and 6-month well child checks. Clinic A is a pediatrics practice, and clinic B is a combined internal medicine and pediatrics practice. After an initial roll-out period in February 2019, Plan-Do-Study-Act cycles were conducted over a 3-month period (March to May 2019) to determine how to reliably and universally incorporate this screening into all applicable visits in the two different clinic settings.
Results: The overall screening rate at clinic A rose from 57% at the beginning of March to 90% at the end of May. Clinic B’s rose from 44% at the beginning of March to 89% at the end of May. With increased screening, there was a rise in both the percentage and the absolute number of women with positive screens.
Conclusions: Screening for PPD in the pediatric setting is feasible and can lead to identification of caregivers in need of further evaluation for PPD that might not have otherwise come to provider attention. Implementing simultaneous quality improvement processes in different sites and sharing findings with a broader healthcare network can expedite effective innovation.
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Copyright (c) 2021 Juliana Stone, MD, MS, Lauren Allen, MD
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