PC1252: Improving Maternal Postpartum Depression Screening in an Urban Pediatric Resident Clinic

Saturday, October 8, 2022

2:15 PM – 3:15 PM US PDT

Location: Anaheim Convention Center, Hall A, Board # 252

Purpose/Objectives: Postpartum Depression (PPD) describes a heterogeneous group of depressive symptoms with onset during the first year following birth. PPD affects 15% of mothers, with an even higher prevalence in low-income communities. PPD can lead to decreased breastfeeding rates, developmental delay, and difficulty implementing safe newborn practices in the home. The AAP released a statement in 2019 that recommends all Pediatric practices incorporate PPD screening into well child visits. At New York Presbyterian-Weill Cornell’s Pediatric Resident clinic, screening rates were estimated to be 57% in 2019. Currently, there is limited literature on improving PPD screening in primary care settings. The objective of this QI study was to design and implement educational and technological changes to improve PPD screening and referral rates in a resident clinic.

Design/Methods: Residents conducted an observational time series study from July 2019 to March 2022. Inclusion criteria were 2 week, 1, 2 and 4 month well visits. Screens were performed using the Edinburgh Postnatal Depression Screen (EPDS). Smart aims included improving both screening rates and referral of positive screens to mental health services to 100%. QI drivers included provider and nursing education, implementation of screening tools in the EMR, and increasing non-English screen availability. Measures were conducted by EMR review. Safe sleep counseling was the balancing measure. Process measure was defined as EPDS administered and scored. Outcome measure was positive EPDS referral. Statistical process control charts and subgroup analyses were used to review data. API rules were applied to detect special cause variation. Additionally, a subgroup of attending and nurse practitioner maternal mental health data was collected through the clinic mental health data repository and compared to resident data.

Results: 866 chart reviewed. Screen completion rate remained constant at 67% despite multiple longitudinal interventions. Scoring rate improved from 93 to 97%. Referral of positive screens was 76%. Balancing measure of safe sleep counseling improved from 74% to 88%. Positive EPDS screening rates were higher when conducted by an attending (21.62%) or nurse practitioner (19.51%) compared to residents (10.89%). For non-English speaking families, 0% of screens were positive compared to 10% in English-speaking mothers.

Conclusion/Discussion: Although screening and referral rates were not sustained, important barriers to screening were identified. Patients of advanced practitioners screened positive more frequently than those screened by residents, suggesting that continuity or level of provider experience may affect maternal response to the EPDS. Despite availability of screens in other languages, lower positivity rate in non-English speaking mothers suggests that language and cultural barriers should be considered when administering EPDS. These findings provide important considerations for other resident clinics and offer guidance for future PDSA cycles in this QI project.

Presenting Author(s)

AB

Alexandra Berardi-Bloomfield, MD

Pediatric Resident
New York Presbyterian Hospital - Weill Cornell Medical
New York, New York

Co-Author(s)

KS

Katherine Schertz, MD

Pediatric Resident
New York Presbyterian-Weill Cornell
New York, New York

Senior Author(s)

MW

Melanie Wilson-Taylor, MD

Assistant Professor Pediatrics, Associate Director of Pediatric Graduate Medical Education.
New York Presbyterian-Weill Cornell
New York, New York

Co-Author(s)

EA

Erika Abramson, MD, MSc

Professor of Pediatrics, Associate Program Director for Pediatric Graduate Medical Education
New York Presbyterian-Weill Cornell
New York, New York
Cori Green, MD, MSc

Associate Professor Pediatrics, Director Behavioral Health Education and Integration in Pediatrics
New York Presbyterian-Weill Cornell
New York, New York
ND

Natasha Dilwali, MD

Pediatric Resident
New York Presbyterian-Weill Cornell
New York, New York
KL

Kala M. Levine, MD

Pediatric Resident
New York Presbyterian-Weill Cornell
New York, New York
JF

Jairo Fonesca, MD

Pediatric Resident
New York Presbyterian-Weill Cornell
New York, New York