Obstetrics and Gynecology, Menninger Department of Psychiatry, Baylor College of Medicine, 6651 Main Street, Houston, TX, 77030, USA.
Public Health Pediatrics, Baylor College of Medicine, 6621 Fannin Street, MC A2275, Houston, TX, 77030, USA.
Matern Child Health J. 2019 Oct;23(10):1292-1298. doi: 10.1007/s10995-019-02780-x.
We report on a successful quality improvement project designed to increase access to perinatal mental health services through universal screening for postpartum depression (PPD) and facilitating referrals for evaluation and treatment, at a multi-site, integrated system of pediatric and obstetric practices in Houston, Texas.
Obstetric practices administered screenings twice during pregnancy and at 6 weeks postpartum. Pediatric practices screened women at the 2 week and 2, 4, and 6-month well-baby visit. Women with a score of 10 or higher on the Edinburgh Postnatal Depression Scale (EPDS) or women that reported thoughts of self-harm were offered a referral to a mental health provider. Data on screening and referrals were collected from the electronic medical record.
A total of 102,906 screens for PPD were completed between May 2014 and July 2018. Of those, 6487 (6.3%) screened positive. The total number of women referred to treatment were 3893 (3.8%). Of referred women 2172 (55.8%) completed an appointment with a mental health provider within 60 days of referral. Rates of completed appointments varied by the level of integration of the mental health provider and referring physician: women referred by pediatrics in a Level 1 coordinated system completed 20.0% of referrals; obstetrics Level 4 co-located system, 76.6%; and obstetrics Level 5 integrated model, 82.7%.
This project demonstrated that with planning, systems review and trained staff, PPD screening can be integrated into obstetric and pediatric practices and high screening and referral rates can be achieved.
我们报告了一个成功的质量改进项目，该项目旨在通过对产后抑郁症（PPD）进行普遍筛查，并为评估和治疗提供便利，来增加得克萨斯州休斯顿的多站点、综合儿科和产科实践中获得围产期心理健康服务的机会。
产科诊所在怀孕期间和产后 6 周进行两次筛查。儿科诊所则在产后 2 周和 2、4、6 个月的婴儿常规健康检查时对女性进行筛查。爱丁堡产后抑郁量表（EPDS）评分达到 10 分或更高的女性，或报告有自杀念头的女性，将获得转介给心理健康服务提供者的机会。电子病历中收集了筛查和转介的数据。
在 2014 年 5 月至 2018 年 7 月期间，共完成了 102906 次 PPD 筛查。其中 6487 例（6.3%）筛查呈阳性。总共转介了 3893 名（3.8%）妇女接受治疗。在转诊妇女中，有 2172 名（55.8%）在转诊后 60 天内与心理健康服务提供者预约。预约完成率因心理健康服务提供者和转诊医生的整合程度而有所不同：儿科一级协调系统转诊的女性完成了 20.0%的转诊；产科四级合作系统为 76.6%；产科五级综合模式为 82.7%。
该项目表明，通过计划、系统审查和培训工作人员，可以将 PPD 筛查整合到产科和儿科实践中，并实现高筛查和转诊率。
