O2116: Improving Evidence-Based Screening of New Mothers for Postpartum Depression in a Primary Care Faculty Practice

Purpose/Objectives: Post Partum Depression (PPD) is estimated to occur in one in eight women, increasing the risk of toxic stress on those infants and adversely affecting critical periods of brain development. PPD can negatively impact the mother-infant dyad, cause disruption of breast feeding, delay development, and increase the risk of abuse and neglect. Despite these serious sequelae of untreated PPD, data shows that more than 50% of women with PPD have gone undiagnosed and only 6.6% of these women received adequate treatment. The AAP Bright Futures Guidelines for Health Supervision recommends that mothers be screened at the 1-,2-,4-, and 6-month WCC visits using a validated screening tool. No process for routine screening existed in our General Pediatrics Faculty Practice so we set out to implement one.

Aim: To increase PPD screening of mothers using a validated screening tool at the 1, 2, 4, and 6 month well child visits from 0 to 80% from September, 2023 to February, 2024, with no difference between primary English and non-English speakers.

Design/Methods: A needs assessment established that pediatricians were unaware of current guidelines for PPD screening, were unfamiliar with screening tools, and did not have a standardized screening practice. Utilizing the Model for Improvement, we created a Simplified Failure Mode Effects Analysis (sFMEA) process map and established Key Drivers. We chose to track utilization of the Edinburgh Postnatal Depression Scale (EPDS) as our outcome measure and began PDSA cycles on 9/25. Our interventions included educating providers and staff, establishing referral resources for positive screens, creating a standardized process, and optimizing the EMR to facilitate orders, documentation, and billing. Efforts were made to improve equity by providing the questionnaire in Spanish as well as English, providing patient education that destigmatizes mental illness, and establishing referrals that are available to underinsured patients.

Results: During our intervention period, our data was consistent with an improvement beyond our goal of 80% of eligible patients screened. Segmented run charts, categorized by patient age and by physician, were also created to identify where to focus further educational efforts during the project. Some of the interventions, including integrating PPD screening into note templates and order sets, further raised the level of reliability.

Conclusion/Discussion: As we increased awareness among the stakeholders about the importance of postpartum mental health screening and created a process that was time efficient, provider hesitancy decreased, and we reached our goal of PPD screening in our practice. We are hopeful that implementing routine screening policies for PPD will lead to increased identification, better connection to care and improved developmental and mental health outcomes for our most vulnerable patients.