GNYHA / NYC DOHMH MATERNAL DEPRESSION QUALITY COLLABORATIVE Participation Application
To improve and standardize depression screening and treatment of women during pregnancy and postpartum, the Greater New York Hospital Association (GNYHA) and New York City Department of Health & Mental Hygiene (DOHMH) want to work with you on the Maternal Depression Quality Collaborative. The Collaborative will: Close gaps on identifying maternal depression, address health disparities, screen and treat all pregnant women and new mothers for depression Reduce depression by connecting women to effective treatment Provide hospitals and their affiliated programs with access to data measuring screening rates to support quality improvement and clinical care In year 2, evaluate the effectiveness of this collaborative by identifying measurable outcomes that can be tracked and trended over time PROJECT DESCRIPTION GNYHA and DOHMH are committed to improving patient outcomes by implementing, when appropriate, standardized, evidence-based best practices. To ensure that the screening and treatment of pregnant women and postpartum mothers promote their psychiatric and physical wellness, and that clinical practice is informed by the most current evidence of perinatal depression s adverse effects, GNYHA and DOHMH are launching the Maternal Depression Quality Collaborative. Hospitals and their affiliated outpatient clinics are invited to participate. Lowering the risk of maternal depression is a leading public health priority. In 2014, 122,084 babies were born in New York City. 1 Depression screening is not routine during pregnancy and postpartum, and an estimated 13% of mothers have postpartum depression 2 (PPD), with 50% left undiagnosed and untreated 3 despite clear evidence that screening and treatment improves outcomes for both mothers and children. 4 Further, 50% of PPD cases are continuations of depressive episodes that occur during or before pregnancy. 5 Treating PPD can reduce mothers recurrent depressive episodes and mitigate harmful effects on their children, such as poor attachment and bonding 6, lower likelihood of breastfeeding 7, poor adherence to child safety practices 8, and use of fewer preventative child services including vaccinations. 9 Treatment of maternal depression is also important for children s social-emotional, language, cognitive, and motor development. Successful treatment of PPD or maternal depression beyond the postpartum period has been associated with improvement in children s emotional and behavioral problems, academic and global functioning, and parent-child interactions. 10 New York City mothers are diverse: 32% White, 30% Hispanic, 20% non-hispanic Black, 17% Asian Pacific Islander, and 47% live in high-poverty neighborhoods. 11 Low-income mothers are disproportionately affected, facing higher rates of perinatal depression and more limited access to diagnosis and treatment than more affluent mothers. 12 Primary prevention and early intervention in the hospital are very powerful perinatal approaches to maternal depression because of the frequent contacts women have with health services at this time. The Agency for Healthcare Research and Quality (AHRQ) found that the potential effectiveness of screening for postpartum depression appears to be related to the availability of systems to ensure adequate follow-up of women with positive results. 13 Currently, there is no uniform standard for perinatal depression screening and treatment in New York hospitals.
In response to these concerns, New York City First Lady Chirlane McCray announced ThriveNYC, an unprecedented commitment by the City of New York to create a mental health system that works for all. ThriveNYC called for a new Maternal Depression Quality Collaborative. Additional efforts and resources to reduce maternal depression include a 2014 New York State law that 1) ensures that hospitals distribute maternal depression educational materials to women during and after pregnancy, and 2) promotes public awareness of maternal depression. Further, the State announced that as of August 1, 2015, screening, referral, and treatment for maternal PPD is reimbursable by Medicaid. The Maternal Depression Quality Collaborative will build on these key policy advancements by working with hospitals that treat expecting and new mothers. The Collaborative will help hospitals identify and treat depression in pregnant women and new mothers by screening at key points during pregnancy and postpartum, and to establish a uniform system to collect data. Participating hospitals will establish protocols to screen all pregnant and postpartum women for depression, and women in need of treatment will be referred as necessary. Participating hospitals will receive support implementing the PHQ-2, PHQ-9, or other validated screening assessment tools, and developing a robust method of collecting and reporting data. The Collaborative s ultimate goal is to increase referrals and improve treatment outcomes. The Maternal Depression Quality Collaborative will follow the Learning Collaborative model in which a group of health care organizations come together, form interdisciplinary teams, test and measure evidence-based practice innovations, and share their experiences to rapidly advance widespread adoption of best practices. Through the identification and sharing of best practices and lessons learned, the Collaborative creates a community in which hospitals help one another work toward a common goal of enhancing outcomes and sustaining improvements. THE MATERNAL DEPRESSION QUALITY COLLABORATIVE WILL: Address the need to create a culture that promotes safety and quality improvement Use a multidisciplinary team approach to patient care Promote effective communication and documentation among members of the treatment team Standardize data collection and measurement in order to monitor the effectiveness of the collaborative interventions and best practices Emphasize transparency by sharing process and outcome data and lessons learned HOSPITAL PARTICIPATION Participation in the Maternal Depression Collaborative requires hospitals to provide the resources necessary to effectively implement clinical and operational strategies to promote patient safety, including: Formal sign-on by hospital CEO Dedicated data and technical support team Participation in project training, site visits, and conference calls An action plan designed and implemented to meet project goals Project reporting
COMMITMENT BY GNYHA AND DOHMH GNYHA and DOHMH have committed resources to ensure that the Collaborative hospitals meet their stated commitments, including: Organizing a Learning Collaborative and facilitating ongoing education and technical support for Collaborative participants Identifying standard screening and referral protocols through a Steering Committee to achieve Collaborative goals Providing participating hospitals with a method to submit screening and treatment data Sharing hospital-specific and aggregate data reports with participants Monitoring progress toward achieving Collaborative goals KEY CONTACTS Alison Burke Vice President, Regulatory and Professional Affairs Greater New York Hospital Association (212) 506-5526 aburke@gnyha.org Aman Nakagawa Deputy Director, Health Integration Policy NYC Department of Health & Mental Hygiene (347) 396-7914 anakagawa@health.nyc.gov Sarah S. Lewis Senior Fellow Greater New York Hospital Association (212) 506-5526 slewis@gnyha.org REFERENCES 1 New York City Department of Health & Mental Hygiene, Bureau of Vital Statistics. http://www.nyc.gov/html/doh/html/pr2015/pr059-15.shtml 2 O Hara MW, Swain AM.(1996). Rates and risk of postpartum depression - a meta-analysis. International Review of Psychiatry, 1996; 8:37-54. 3 Peindl, KS, Wisner, KL & Hanusa, BH. Identifying depression in the first postpartum year: Guidelines for screening and referral, Journal of Affective Disorders, 2004;80(1):37-44. 4 Peindl, KS, Wisner, KL & Hanusa, BH. Identifying depression in the first postpartum year: Guidelines for screening and referral, Journal of Affective Disorders, 2004;80(1):37-44. 5 Chaudron, LH. Postpartum depression: what pediatricians need to know. Pediatrics in Review, 2003; 24(5): 154-161. 6 Gjerdingen, DK & Yawn, BP. Postpartum depression screening: Importance, methods, barriers, and recommendations for practice. Journal of the American Board of Family Medicine, 2007; 20; 280-288. 7 National Research Council and Institute of Medicine (NRC & IOM). Depression in parents, parenting, and children: Opportunities to improve identification, treatment, and prevention. Committee on Depression, Parenting Practices, and the Healthy Development of Children. Board on Children, Youth, and Families. Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press, 2009. 8 Field, T. Postpartum depression effects on early interactions, parenting, and safety practices: A review.(2010). Infant Behavior and Development, 2011; 33(1): 1. 9 Zimmerman, R., Li, W., Gambatese, M., Madsen, A., Lasner-Frater, L., Van Wye, G., Kelley, D., Kennedy, J., Maduro, G., Sun, Y. (2013). Summary of vital statistics, 2012: Pregnancy outcomes. New York, NY: NYCDOHMH, Office of Vital Statistics. 10 National Research Council and Institute of Medicine (NRC & IOM). Depression in parents, parenting, and children: Opportunities to improve identification, treatment, and prevention. Committee on Depression, Parenting Practices, and the Healthy Development of Children. Board on Children, Youth, and Families. Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press, 2009. 11 O Hara M, Swain A. Rates and risk of postpartum depression - a meta-analysis. International Review of Psychiatry, 1996; 8:37-54 12 O Hara MW, Swain AM.(1996). Rates and risk of postpartum depression - a meta-analysis. International Review of Psychiatry, 1996; 8:37-54. 13 Myers ER, Aubuchon-Endsley N, Bastian LA, Gierisch JM, Kemper AR, Swamy GK, Wald MF, McBroom AJ, Lallinger KR, Gray RN, Green C, Sanders GD. Efficacy and Safety of Screening for Postpartum Depression. Comparative Effectiveness Review 106. (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-2007-10066-I.) AHRQ Publication No. 13-EHC064-EF. Rockville, MD: Agency for Healthcare Research and Quality; April 2013.www.effectivehealthcare.ahrq.gov/ reports/final.cfm.
GREATER NEW YORK HOSPITAL ASSOCIATION NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE MATERNAL DEPRESSION QUALITY COLLABORATIVE PARTICIPATION APPLICATION Please return the application to: Sarah S. Lewis, Senior Fellow Greater New York Hospital Association 555 West 57th Street New York, NY 10019 (212) 506-5526 slewis@gnyha.org Maternal Depression Quality Collaborative. will participate in the GNYHA/DOHMH President and Chief Executive Officer: Organization: Date: Maternal Depression Quality Collaborative Project Team: Chief Medical Officer or Designated Physician Day-to-Day Collaborative Project Manager/Key Contact
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