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
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 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