Perinatal Obstetric Office Depression Screening and Treatment Implementation in a Health Care System
Perinatal Obstetric Office Depression Screening and Treatment Implementation in a Health Care System
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DOI：
10.1097/aog.0000000000001395
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发表时间：
2016-05-01
影响因子：
7.2
通讯作者：
Avalos, Lyndsay A.
中科院分区：
文献类型：
--
作者：
Flanagan, Tracy;Avalos, Lyndsay A.
围产期抑郁症影响12%至20%的孕妇和产后妇女，并且诊断不足。美国妇产科医师学会和美国预防服务工作组最近建议普遍进行围产期抑郁症筛查。我们讨论的挑战，建立普遍筛查，描述的开发和实施之间的2007年和2014年的凯撒永久北方加州的成功计划，并强调成功的关键措施。质量改进系统方法有四个步骤指导开发：1）确定和使用最佳实践，2）确定冠军和教育临床医生，3）使用数据驱动性能，以及4）简化办公室工作流程。从诊断到120天后，抑郁症护理指标至少改善50%，这决定了临床成功。从电子健康记录中提取了2014年所有出生（N= 37，660）的抑郁症诊断，患者健康问卷-9评分，药物分配和治疗。96%的孕妇和产后妇女至少接受过一次筛查。14%的人抑郁症筛查呈阳性（患者健康问卷-9分10分或更高）。大约6%的孕妇和产后妇女患有严重抑郁症，患者健康问卷调查- 9分15分或更高，并诊断为抑郁症，其中80%的妇女接受了治疗。40%被诊断为抑郁症的女性表现出症状改善。北方加州的Kaiser Permanente的普遍围产期抑郁症筛查项目可以作为产科护理普遍抑郁症筛查的可行性和临床有效性的模型。
Perinatal depression affects between 12% and 20% of pregnant and postpartum women and is underdiagnosed. The American College of Obstetricians and Gynecologists and the U.S. Preventive Services Task Force recently recommended universal perinatal depression screening. We discuss challenges to instituting universal screening, describe the development and implementation between 2007 and 2014 of Kaiser Permanente Northern California's successful program, and highlight key measures of success. A quality improvement system approach with four steps guided development: 1) identify and use best practices, 2) identify champions and educate clinicians, 3) use data that drive performance, and 4) streamline office workflow. Clinical success was determined by at least 50% improvement in depression care metrics from diagnosis to 120 days afterward. Depression diagnoses, Patient Health Questionnaire-9 scores, medication dispensation, and treatment for all births in 2014 (N=37,660) were extracted from electronic health records. Ninety-six percent of pregnant and postpartum women were screened at least once. Fourteen percent screened positive for depression (Patient Health Questionnaire-9 score of 10 or greater). Approximately 6% of pregnant and postpartum women had severe depression with a Patient Health Questionnaire- 9 of 15 or greater and a depression diagnosis, and 80% of these women received treatment. Forty percent of women with a depression diagnosis demonstrated improved symptoms. Kaiser Permanente Northern California's universal perinatal depression screening program can serve as a model for the feasibility and clinical effectiveness of universal depression screening in obstetric care.