Maternal Depression Addressed Sooner Due to CCNC’s Pregnancy Medical Home
When it comes to postpartum depression screening, the earlier the better, say physicians with CCNC’s Pregnancy Medical Home Program (PMH). Depression can have a major negative influence on both a new mother and her infant. That’s why PMH launched its first statewide quality improvement project earlier this year aiming to improve the percentage of mothers receiving comprehensive postpartum care within 60-days of giving birth. Moving the traditional “six-week postpartum visit” to a 3-4 week period was a key best practice, as were reminder phone calls, rapid phone outreach to patients missing visits, setting up the postpartum visits before delivery, and confirming patients have scheduled visits before discharge from the hospital. The shorter time frame allows clinicians to address breastfeeding challenges or maternal depression sooner, promotes access to contraception before the risk of an unintended pregnancy, and provides more time to stay within the recommended timeframe should the patient miss the initial appointment.
According to the PMH Care Pathway on Postpartum Care and the Transition to Well-Woman Care, the optimal timing for the postpartum visit is between 14-42 days after delivery. This time frame aligns with recent recommendations from the American College of Obstetricians and Gynecologists on the importance of postpartum visits within 6-weeks of birth.
Comprehensive postpartum visits enable new mothers to receive timely follow-up to any pregnancy complication. The visits also offer the opportunity for ongoing chronic disease management, the initiation of family planning discussions, and helps providers transition mothers to well-woman or “interconception” care that reduces their risks of complications in future pregnancies.
Forty-five PMH practices from across CCNC’s 14 networks are currently participating in the project. Practices represent a wide cross section and include many private OB/GYN offices, several health department maternity clinics, a number of academic medical center OB clinics, and one family medicine practice. As part of the project, each practice completed a formal chart review/claims audit process that allowed them to measure their postpartum visit rate. Practices identified missed opportunities and workable strategies for improvement.
CCNC’s OB teams are now working on spreading this and other successful strategies to the 340 PMH practices across the state.
The project will continue through the end of 2016. Participating sites will continue to test changes and monitor their postpartum visit rates.