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  2. CQM-1224

Mother's mental health assessment documented in child's medical record with no way to link the outcomes of assessment to the mother's EMR for tracking, assessment or follow-up and violates mother's right to privacy.

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Icon: Minor Minor
    • Measure
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      This measure specification does not require the pediatrician to provide care to the mother, but rather looks for a screening to prevent potential problems for both the mother and infant. Pediatricians and primary care physicians may present the best opportunity for screening mothers due to the frequency of visits during the earlier years of a child’s life.[i] Office interventions take little time to conduct and are effective in detecting those mothers in need of further help, thus making them feasible to conduct in every well-child visit encounter.[ii],[iii] Though pediatricians are not able to diagnose depression, especially if the mother is not a regular patient, they may be in a good position to discuss depressive disorders, the impact on children, and possibilities of help.[iv] One study found that when pediatricians discussed depression with mothers after a written standardized screen, more women were referred for additional help. Pediatricians can discuss with parents the importance of a support system, the importance of taking time away from the baby, the common feeling of being upset, and the importance of never yelling, hitting, or shaking the baby.[v]
      Moreover, pediatricians are in an advantageous position to screen mothers as they have more direct interaction than the mother’s regular caregiver. In the postpartum women are more likely to bring their child to checkups than they are to revisit their gynecologist/obstetrician or their primary care provider. Some estimates state that half of women do not attend a postpartum visit, however depressed mothers and low income mothers are the least likely to attend. Pediatricians have the opportunity to see the mother upwards of eight times in the two years postpartum.[vi]

      We recognize that practices will need to consider and address the privacy issues. However, this measure aligns with an AAP recommendation. The AAP may be able to provide some guidance about privacy when screening mothers for postpartum depression. Please see the links below for more information.

      http://pediatrics.aappublications.org/content/early/2010/10/25/peds.2010-2348.full.pdf+html

      http://www2.aap.org/sections/dbpeds/pdf/Screening%20for%20Maternal%20Perinatal%20Depression.pdf

      http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Managing-Maternal-Depression-Before-and-After-Birth.aspx


      [i] VanLandeghem, Karen, MPH. National Academy for State Health Policy. Financing Strategies for Medicaid Reimbursement of Maternal Depression Screening by Pediatric Providers. April 2006.
      [ii] Olson,AL, et al. Brief Maternal Depression Screening at Well-Child Visits. Pediatrics Volume 118, Number 1, July 2006
      [iii] Ibid.
      [iv] Ibid.
      [v] Hagan, JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove, IL: American Academy of Pediatrics.
      [vi] Feinberg., E., Sc.D., C.P.N.P., et al. Report from the CDC. Improving Women’s Health during Internatal Periods: Developing an Evidenced-Based Approach to Addressing Maternal Depression in Pediatric Settings. Journal of Women’s Health. Vl15, No. 6, 2006
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      This measure specification does not require the pediatrician to provide care to the mother, but rather looks for a screening to prevent potential problems for both the mother and infant. Pediatricians and primary care physicians may present the best opportunity for screening mothers due to the frequency of visits during the earlier years of a child’s life.[i] Office interventions take little time to conduct and are effective in detecting those mothers in need of further help, thus making them feasible to conduct in every well-child visit encounter.[ii],[iii] Though pediatricians are not able to diagnose depression, especially if the mother is not a regular patient, they may be in a good position to discuss depressive disorders, the impact on children, and possibilities of help.[iv] One study found that when pediatricians discussed depression with mothers after a written standardized screen, more women were referred for additional help. Pediatricians can discuss with parents the importance of a support system, the importance of taking time away from the baby, the common feeling of being upset, and the importance of never yelling, hitting, or shaking the baby.[v] Moreover, pediatricians are in an advantageous position to screen mothers as they have more direct interaction than the mother’s regular caregiver. In the postpartum women are more likely to bring their child to checkups than they are to revisit their gynecologist/obstetrician or their primary care provider. Some estimates state that half of women do not attend a postpartum visit, however depressed mothers and low income mothers are the least likely to attend. Pediatricians have the opportunity to see the mother upwards of eight times in the two years postpartum.[vi] We recognize that practices will need to consider and address the privacy issues. However, this measure aligns with an AAP recommendation. The AAP may be able to provide some guidance about privacy when screening mothers for postpartum depression. Please see the links below for more information. http://pediatrics.aappublications.org/content/early/2010/10/25/peds.2010-2348.full.pdf+html http://www2.aap.org/sections/dbpeds/pdf/Screening%20for%20Maternal%20Perinatal%20Depression.pdf http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Managing-Maternal-Depression-Before-and-After-Birth.aspx [i] VanLandeghem, Karen, MPH. National Academy for State Health Policy. Financing Strategies for Medicaid Reimbursement of Maternal Depression Screening by Pediatric Providers. April 2006. [ii] Olson,AL, et al. Brief Maternal Depression Screening at Well-Child Visits. Pediatrics Volume 118, Number 1, July 2006 [iii] Ibid. [iv] Ibid. [v] Hagan, JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove, IL: American Academy of Pediatrics. [vi] Feinberg., E., Sc.D., C.P.N.P., et al. Report from the CDC. Improving Women’s Health during Internatal Periods: Developing an Evidenced-Based Approach to Addressing Maternal Depression in Pediatric Settings. Journal of Women’s Health. Vl15, No. 6, 2006
    • Patient Confidentiality, Patient Care, Scope of Practice

      Although the intent of this measure is understandable in addressing post-partum depression and the potential risk to the child, this measure is flawed in measuring patient encounter's who are less than 6 months of age. Measuring patient encounters for this infant population requires Pediatricians to assess a mother's post- partum depression during the child's visit. This requires the mother's mental health assessment to be documented within the child's medical record with no way to link the outcomes of this assessment to the mother's medical record for tracking, assessment or follow-up by other's who are part of the mother's care team. This is significant for both treatment purposes and privacy. When there is a positive depression screening and the Pediatrician becomes the adult care giver there are then legal issues surrounding a Pediatrician's responsibility for treatment, follow-up etc. of an adult patient population he is not certified to treat. This also becomes a privacy issue. All legal guardians have a right to look at the child's medical record until the age of 18 and at that time the child himself has the right to access his medical record which violates the mother's rights to privacy.

            edave Mathematica EC eCQM Team
            jbradfo2 Jill Bradford-Shuemaker (Inactive)
            Jill Bradford-Shuemaker (Inactive)
            Colin Andrew Banas (Inactive)
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