Institute for Public Health and Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, United States of America.
Education Development Center, Inc., Waltham, MA, United States of America.
PLoS One. 2020 Apr 16;15(4):e0230211. doi: 10.1371/journal.pone.0230211. eCollection 2020.
Maternal depression is common among low-income women enrolled in home visiting programs, yet there is considerable variability in the extent to which it is identified and addressed. This study examines outcomes related to postpartum depression screening, receipt of evidence-based services, and reductions in depressive symptoms among clients of home visiting programs in the Health Resources and Services Administration's Maternal, Infant, and Early Childhood Home Visiting Program Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN), the first U.S. national application of the Institute for Healthcare Improvement's Breakthrough Series (BTS) Model in home visiting programs.
Fourteen home visiting programs in eight states, serving a geographically and racially diverse caseload of pregnant women and new mothers, took part in the HV CoIIN. Women in participating home visiting programs received the intervention strategies implemented by their program during participation in the collaborative. HV CoIIN strategies included specific policies and protocols for depression screening and home visitor response to screening results; home visitor training and supervision; delivery of prevention and treatment interventions; and tracking systems for screening, referral, and follow-up. HV CoIIN's proposed primary outcome was that 85% of women who accessed evidence-based services would experience a 25% reduction in depressive symptoms three months after accessing services. Secondary outcomes included an increased percentage of women who were screened for depression within three months of enrollment or birth, who verbally accepted a referral to evidence-based services, and who received one or more evidence-based service contacts. HV CoIIN resulted in improved symptoms among women who accessed services, from 51.1% to 59.9%. HV CoIIN also improved the percent of women screened for depression, from 83.6% to 96.3%, and those with positive depression screens who accessed evidence-based services, from 41.6% to 65.5%. Home visiting programs in this study were early adopters of quality improvement activities, which may limit the generalizability of these results to other home visiting programs.
Home visiting programs can play an important role in closing gaps in maternal depression identification, referrals, service access, and symptom alleviation. Continuous quality improvement and BTS collaborative methods can be used to improve home visiting services in ways that advance national public health priorities and improve population health outcomes.
在参加家访项目的低收入妇女中，产妇抑郁较为常见，但在识别和处理这种情况的程度上存在很大差异。本研究考察了与产后抑郁症筛查、获得循证服务以及家访项目客户的抑郁症状减轻相关的结果，这些客户是卫生资源和服务管理局母婴和儿童早期家访计划家访合作改进和创新网络（HV CoIIN）的一部分，这是美国在家庭访视项目中首次应用医疗改善研究所突破性系列（BTS）模式。
来自八个州的 14 个家访项目参与了 HV CoIIN，为孕妇和新妈妈提供了地理和种族多样化的服务。参加家访项目的妇女在参与合作时接受了项目实施的干预策略。HV CoIIN 策略包括抑郁症筛查的具体政策和方案以及家访员对筛查结果的反应；家访员培训和监督；预防和治疗干预措施的提供；以及筛查、转诊和随访的跟踪系统。HV CoIIN 的主要预期结果是，接受循证服务的 85%的妇女在接受服务三个月后，其抑郁症状将减轻 25%。次要结果包括在入组或分娩后三个月内接受抑郁症筛查的妇女比例增加、口头接受向循证服务转诊的妇女比例增加以及接受一次或多次循证服务接触的妇女比例增加。HV CoIIN 改善了接受服务的妇女的症状，从 51.1%提高到 59.9%。HV CoIIN 还提高了接受抑郁症筛查的妇女比例，从 83.6%提高到 96.3%，以及接受抑郁症筛查呈阳性并接受循证服务的妇女比例，从 41.6%提高到 65.5%。本研究中的家访项目是质量改进活动的早期采用者，这可能限制了这些结果在其他家访项目中的推广。
家访项目可以在缩小产妇抑郁症识别、转诊、服务获取和症状缓解方面的差距方面发挥重要作用。持续质量改进和 BTS 合作方法可用于改进家访服务，以推进国家公共卫生重点和改善人口健康结果。
