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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Postpartum Mental Health Screening.

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Strategy. Quality Improvement Initiatives

Approach. Support hospital quality improvement initiatives that take a multicomponent, systematic approach to increase postpartum depression and anxiety screening rates.

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Overview. Hospitals that support quality improvement (QI) initiatives that enact standardized screening protocols and referral pathways, staff and patient engagement, and use a multi-component, systematic approach to encourage postpartum depression and anxiety screening are likely to increase screening and referral rates.[1,2,3] Research supports that QI initiatives that utilize a standardized postpartum depression and anxiety screening tool been have shown to be effective in increasing screening rates.[1,2] QI initiatives have also been studied in specialized populations such as incarcerated women, and have shown to have positive outcomes in increasing screening rates.[3]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Mental Health. This strategy promotes emotional, psychological, and social well-being of individuals and communities.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of hospitals that initiate quality improvement projects focused on increasing postpartum depression and anxiety screening rates. (Measures the uptake and spread of the quality improvement strategy)
  • Number of hospital staff, including providers, nurses, and administrators, who receive training on best practices for postpartum mental health screening as part of quality improvement initiatives. (Assesses the engagement and capacity-building of the healthcare workforce in quality improvement efforts)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of hospital postpartum depression and anxiety screening quality improvement initiatives that utilize data-driven, iterative methods such as the Plan-Do-Study-Act. (PDSA) cycle. (Measures the adherence to established quality improvement frameworks and methodologies)
  • Percent of hospital postpartum mental health screening quality improvement initiatives that engage patients and families as active partners in the redesign and evaluation of care process. (Measures the level of patient and family engagement in quality improvement efforts)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of hospital-community partnerships led by Title V established to support seamless transitions of care and follow-up for postpartum women with positive depression and anxiety screens who report high levels of engagement. (Measures efforts to build a coordinated and responsive postpartum mental health system of care)
  • Number of hospital-based patient and family education programs that raise awareness about postpartum mental health and the importance of screening as part of quality improvement efforts. (Shows strategies to support and engage postpartum women and families as partners in care)

OUTCOME MEASURES:

  • Number of hospitals that demonstrate significant reductions in postpartum mental health-related adverse events, readmissions, or maternal morbidity and mortality rates as a result of improved screening practices driven by quality improvement initiatives. (Assesses the clinical and safety outcomes associated with the quality improvement strategy)
  • Number of state or regional perinatal quality collaboratives that adopt and spread hospital-based postpartum mental health screening quality improvement initiatives as a standard of care. (Measures the strategy's influence on driving system-level change and accountability for postpartum mental health)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of hospital-community partnerships led by Title V established to support seamless transitions of care and follow-up for postpartum women with positive depression and anxiety screens who report high levels of engagement. (Measures efforts to build a coordinated and responsive postpartum mental health system of care)
  • Percent of hospital-based patient and family education programs that raise awareness about postpartum mental health and the importance of screening as part of quality improvement efforts. (Shows strategies to support and engage postpartum women and families as partners in care)

OUTCOME MEASURES:

  • Percent of hospitals that demonstrate significant reductions in postpartum mental health-related adverse events, readmissions, or maternal morbidity and mortality rates as a result of improved screening practices driven by quality improvement initiatives. (Assesses the clinical and safety outcomes associated with the quality improvement strategy)
  • Percent of state or regional perinatal quality collaboratives that adopt and spread hospital-based postpartum mental health screening quality improvement initiatives as a standard of care. (Measures the strategy's influence on driving system-level change and accountability for postpartum mental health)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Berns, H. M., & Drake, D. (2021). Postpartum depression screening for mothers of babies in the neonatal intensive care unit. MCN: The American Journal of Maternal/Child Nursing, 46(6), 323-329.
[2] Toler, S., Stapleton, S., Kertsburg, K., Callahan, T. J., & Hastings-Tolsma, M. (2018). Screening for postpartum anxiety: A quality improvement project to promote the screening of women suffering in silence. Midwifery, 62, 161-170.
[3] Puryear, L. J., Nong, Y. H., Correa, N. P., Cox, K., & Greeley, C. S. (2019). Outcomes of implementing routine screening and referrals for perinatal mood disorders in an integrated multi-site pediatric and obstetric setting. Maternal and child health journal, 23, 1292-1298.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.