Page Comparison

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1. Depression Screening: The percentage of deliveries in which members were screened for clinical depression using a standardized instrument during the postpartum period. [within 12 weeks of delivery?]

   Follow-Up on Positive Screen: The percentage of deliveries in which members received follow-up care within 30 days of a positive depression screen finding.

   1. retest to show improvement (easier with PHQ-2)

2. Follow up diagnoses of post-partum depression?

3. Number of screens?

• “Appropriate screening at the comprehensive post-partum visit”

  • Screen at every visit? - varies by health center

  • Link to UDS measure Preventive Care and Screening: Screening for Depression and Follow-Up Plan (Line 21), CMS2v9 and Depression Remission at Twelve Months (Line 21a), CMS159v8

• Validated tools for screening?

  • Edinburgh? (EDPS)-- short vs long

  • PDSS: Comparative analysis of the performance of the Postpartum Depression Screening Scale with two other depression instruments

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• PHQ-2, PHQ-9 - most health centers probably have this already

• Other validated tools?

• PHQ-9 vs EDPS: Patient health questionnaire-9 versus Edinburgh postnatal depression scale in screening for major depressive episodes: a cross-sectional population-based study

  • PHQ-9 validated longitudinally, may be becoming preferred

  • Not possible to map/provide equivalence scores?

• Patients with prior screening in pregnancy?

• High risk patients/SMI [exclude from measure]

  • SMI diagnosis codes?

  • Mood disorder diagnosis codes?

  • Prior history of PPMD

• Addressing PP anxiety/psychosis?-- EDPS does this

• Emergent treatment: active SI, psychosis – gather data? offer resources at the health centers? (link to relevant EDPS elements)

  • Flag positive high risk questions

  • https://www.samhsa.gov/find-help/national-helpline

• Implementation approach:

  • Screening:

    • Screen in clinic

    • Can send via patient portal

  • View PP screening data:

    • Part of postpartum note-- prepopulate screening dates and scores

    • Measure on OB dashboard

  • Follow up:

    • Generate a structured referral – ideally to close the loop

    • Dashboard?

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• Post-partum HTN screening and management is critical

  • Consider capturing in dataset all BP measurements in critical periods

  • Need to get data from hospital setting – look for dx and BP if possible (get data from Alliance Quality Collaborative)

    • Consider use of direct secure messaging (could be used for all follow up actions)

    • F/u on FHIR/ADT requirements from hospital discharge

ACOG: https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/06/gestational-hypertension-and-preeclampsia

(NICE 1.9): (replace with ACOG)

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