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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.
retest to show improvement (easier with PHQ-2)
Follow up diagnoses of post-partum depression?
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
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PHQ-2, PHQ-9 - most health centers probably have this already
Other validated tools?
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
Implementation approach:
Screening:
Screen in clinic- EDPS, PHQ2/9
What constitutes a positive screen? need dummy element “screen+”
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
OR a visit with a diagnosis of PPMD
OR a behavioral health encounter with PMDD
OR a new SSRI?
Dashboard?
PPMD Denominator 1: Women with a pregnancy ending in delivery
Numerator 1: Screening for PMDD was completed
PPMD Denominator 2: Screening for PMDD was positive
Numerator 2: Follow up visit occurred (medical or behavioral health) OR referral was provided
Cardiovascular care
Hypertension:
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Chronic hypertension—Hypertension that is present at the booking visit or before 20 weeks’ gestation, or if the woman is already taking antihypertensive medication when starting maternity care. It can be primary or secondary in aetiologyetiology
Gestational hypertension—New hypertension presenting after 20 weeks of pregnancy without significant proteinuria
Pre-eclampsia—New onset hypertension (>140 mm Hg systolic or >90 mm Hg diastolic) after 20 weeks of pregnancy and the coexistence of one or both of the following new-onset conditions:
Proteinuria (urine protein:creatinine ratio ≥30 mg/mmol, or albumin:creatinine ratio ≥8 mg/mmol, or ≥1 g/L [2+] on dipstick testing)
Other maternal organ dysfunction, including features such as renal or liver involvement, neurological or haematological complications, or uteroplacental dysfunction (such as fetal growth restriction, abnormal umbilical artery Doppler waveform analysis, or stillbirth)
Combination of these is possible:
Highest risk patients are combined chronic HTN and Pre-eclampsia or early Pre-eclampsia
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HTN screening:
HTN Denominator 1: Women with pregnancy >20 weeks
HTN Numerator 2: Women with BP and urine protein screening
HTN Denominator 2: Women with chronic HTN and gestational HTN
HTN Numerator 2: High risk follow up and low dose aspirin
HTN Denominator 3: Women in high risk follow up
HTN numerator 3a: Women with BP >160/110/diagnosis of Preeclampsia, Eclampsia or HELLP
HTN numerator 3b: Women with 7 day follow up after delivery (BP check and symptom check)
(NICE 1.9): (replace with ACOG)
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pathway for care and coordination with BH, L&D
SUD Denominator 1: All pregnancies
SUD Numerator 1: Presence of SUD screening
SUD Denominator 2: Presence of SUD (high risk: SUD status)
SUD Numerator 2: Presence of follow up for SUD: referral, behavioral health, SUD counseling or treatment program
Other supporting evidence-based recommendations for postpartum care services:
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CMS Exclusive Breastfeeding:
https://cmit.cms.gov/CMIT_public/ViewMeasure?MeasureId=2579
Denominator 1 BF: All pregnancies ending in delivery of one or more live neonate
Numerator 1 BF: Patient is exclusively BF, partially BF or not BF
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