CP30 - Creative Solutions to Postnatal Care: Mom-Baby Dyad Visits in the Pediatric Primary Care Setting

Poster Type: Innovation

Category: Quality of Care and Quality Improvement

Issue or Challenge: Child health and development is inextricably linked to maternal health and wellbeing. However, for a variety of reasons, many women miss their postpartum care appointments and instead prioritize their children’s care. This results in unaddressed postpartum mood disorders and lack of postpartum contraception among other unmet needs that can have negative implications for the entire family. Offering mom-baby dyad visits in the pediatric primary care setting is a patient-centered innovation to improve postpartum care rates by decreasing the barrier of a separate appointment and by integrating infant mental health providers to emphasize the connection between maternal and infant health.

Description of Innovation: When newborns are seen for their 2 day weight check visit with clinic nurses, they are offered a mom-baby dyad visits at 2 and 6 weeks postpartum. During dyad visits mothers and babies are seen by a family physician in the pediatrics clinic who can address all postpartum care needs as well as routine well infant care needs. Topics covered include, but are not limited to, breastfeeding, contraception, maternal mood, child development, infant care, and 2 month immunizations. If needed the dyad provider can prescribe contraception and place long acting reversible contraceptives (LARCs) during these visits. All mothers are screened with the Edinburgh Perinatal Depression Scale (EPDS), and whether positive or negative, they are introduced to one of our infant mental health (IMH) specialists for a discussion of the importance of maternal mental health for bonding and child development. The IMH specialist can provide brief therapy and refer to ongoing support as needed. Following the 2 week and 6 week dyad visits, the dyad provider can remain PCP for both mom and baby, or if the family already has a primary care pediatrician for their family and the mom has an adult PCP, they can transition back to those providers.

Impact or Result: In the first 2 years of this program we completed 504 dyad visits. The no-show rate for dyad visits was 19.15% compared to 35.31% no-show rate for postpartum visits at the women’s care clinic that is co-located and where women would otherwise be scheduled for postpartum care. During dyad visits 29 contraceptive implants and 28 IUDs were placed. Westside Pediatrics screened 98.7% of all patients for pregnancy related depression, and 75% of those who screened positive had appropriate behavioral health follow up, though these numbers were not for dyad visits specifically. On patient satisfaction questionnaires, 100% of patients surveyed reported being “very satisfied” with the care they and their baby received and being likely to recommend a dyad visit to friends and family. On staff satisfaction questionnaires, staff overall reported very positive feedback despite some initial hesitancy about the program, and feedback by role will be presented in more detail.

Replicating this Innovation: To replicate this innovation in a pediatrics clinic, organizations need a family physician or APP embedded in a pediatrics clinic capable of seeing both postpartum women and children as well as a behavioral health provider comfortable working with postpartum women. The clinic also needs supplies for GYN procedures and training for medical assistants in setting them up. Additionally a routine processes for distributing, reviewing, and entering EPDS questionnaires is necessary. In a family medicine clinic, scheduling women and children together would be an even easier transition as the appropriate medical providers are already present in the clinic.

Author(s):

Haley Ringwood, MD, MPH, Assistant Professor of Family Medicine, Denver Health

Margaret Tomcho, MD, MPH, MBA, Medical Director, Westside Pediatric and Adolescent Clinic, Denver Health

Caitlin Hernandez, PhD, Licensed Psychologist, Denver Health