691 - Resident Led Quality Improvement Project Incorporating a Clinical Psychologist to Improve Screening and Referral Rates for Postpartum Depression in a Pediatric Primary Care Clinic

Poster Number: 691
Publication Number: 691.152

Julie Davila, NewYork-Presbyterian Komansky Children’s Hospital, new York, NY, United States; Kelly M. Banks, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Alim Esemenli, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Matthew Tam, NewYork-Presbyterian Komansky Children’s Hospital, New York City, NY, United States; Bing Lin, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Emily Scharf, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Radha Sathanayagam, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Samantha Bruno, NewYork-Presbyterian Komansky Children’s Hospital, NY, NY, United States; Diane Lee, Weill Cornell Medicine, New york, NY, United States; Erika Abramson, NewYork-Presbyterian Komansky Children’s Hospital, Rye Brook, NY, United States; Snezana Nena Osorio, Weill Cornell Medical College, New York, NY, United States; Nancy J. Lee, Weill Cornell Medicine, Long Island City, NY, United States

Background: Postpartum depression (PPD) is the most common obstetric complication affecting both mothers (10-16%) and their infants. At a Medicaid-based clinic, baseline screening rates in 2021 were 66%, despite efforts to increase screening through prior QI initiatives. Integration of a clinical psychologist into primary care clinic (through a program known as “HealthySteps”) improves screening and referral for PPD.

Objective: By June 2023, a resident-led QI team will increase PPD screening during well child visits to 90%. Secondary aim is to increase referral rates to appropriate mental health care to 100%.

Design/Methods: This is an ongoing observational time-series study over 23 months in a primary care clinic affiliated with a tertiary academic medical center. An interdisciplinary QI team including residents, attending physicians, a QI specialist, and psychologist created a key driver diagram (Figure 1). Interventions were derived using tertiary drivers (Figure 1) and tested via 2 PDSA cycles. Process (screening), outcome (mental health referral) and balancing (safe sleep counseling) were collected via EMR review at 2-week, 1-, 2- and 4-month well child visits. PPD screens were translated into 12 languages. Statistical process control charts, run charts and subgroup analyses were used to display and analyze data. Run chart rules and API rules were applied to detect signal of change and special cause variation respectively.

Results: 715 charts were reviewed. Overall PPD screening rate improved from 66 to 85% (Figure 2), while previously improved scoring remained high at 98%. Positive screening rate remained unchanged at 10%, while referral rate of patients who scored positive improved from 60 to 87% (Figure 3). Subgroup analysis showed the lowest screening rate at the 2- week visit. Only 50% of newly introduced, non-English PPD screens were completed (23/42). There was no change in safe sleep counseling (balancing measure).

Conclusion(s): Integration of a clinical psychologist into the resident clinic was effective in improving both screening and referral rates. The lower screening rates observed at 2-week visits may be due to the focus on weight trends. Given the lower number of non-English screens completed, improving workflow, and educating staff on how to perform non-English screens is important for further success and reducing disparities. Future interventions for this ongoing project include implementing note templates for 2-week visits, modifying existing note templates to track outcomes and languages of completed screens.