By Ian Bennett & the MInD-I Team
Around fifteen percent of women in pregnancy and the year postpartum suffer from common mental disorders such as depression (perinatal depression) or anxiety, yet evidence-based strategies to identify and treat these conditions are rarely used in their medical care. Many health care providers are unaware that these serious disorders – which impact both mothers and their children – are equally common in pregnancy as postpartum, or that suicide, usually occurring among those with depression, is a leading cause of maternal mortality. The Maternal Infant Dyad – Implementation (MInD-I) project brings the collaborative care model to participating members of the OCHIN community health center (CHC) network. Collaborative care is a team-based, patient centered strategy shown in more than eighty trials to improve outcomes for diverse primary care patients with depression, including pregnant and postpartum women.
MInD-I is one of many efforts led by OCHIN to bring value to its members. It is a collaboration with national leaders in mental health care from the University of Washington (UW), University of Pennsylvania, and Washington University of Saint Louis among others. Project funding comes from the National Institutes of Health and the California Health Care Foundation, and provides participating clinics with twenty-four months of support for implementing and sustaining changes to operations, work flow, and clinical access to mental health specialty care, focused on perinatal depression. Specific elements include training in the use of OCHIN’s new perinatal depression care registry in the Epic electronic health record, support by implementation coaches from OCHIN’s Operational Excellence (OpEx) team, clinical training from the UW’s AIMS Center, and setting up mental health specialty consultations. This care model is consistent with Patient-Centered Medical Home certification, and with the National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services quality metrics efforts, which will affect reimbursement models for most clinical practices nationally. Thus, MInD-I will help participants prepare to meet these metrics.
MInD-I will eventually include up to twenty OCHIN practices. The first six practices – located in California, Texas, and Wisconsin – began implementation in March 2017 and are now well into delivering collaborative care focused on perinatal depression. Following implementation of MInD-I in one clinic, its project leader noted: “Before this project, many staff had their own lists of patients they were concerned about, either in their head or on sticky notes. Having a list of patients to work from in Epic is useful to organize and track our perinatal patients who are at risk, and ensure that no one falls through the cracks.”
Managing perinatal depression requires interdisciplinary teamwork, where primary care teams work in tandem with each other and mental health specialists, ideally supported by EHR tools that enhance care delivery. The MInd-I project is designed to facilitate this process. Most importantly, the successful implementation of MInD-I will help CHCs address common mental health needs that often leave many suffering in silence.
We are currently recruiting sites to participate in the next wave of implementation work for MInD-I. If your health center provides care for pregnant and postpartum women and is interested in learning more about implementing collaborative care and using OCHIN’s new Epic patient registry EHR tool, please contact April Lee.