Post-partum depression (PPD) affects one in seven women. Untreated PPD can have devastating consequences including pregnancy-associated suicide, which has remained among the leading contributors to maternal mortality in the United States. Collaborative care (CC) has been shown in randomized trials to improve PPD outcomes. However, a major challenge in the implementation of postpartum collaborative care is the overburdened role of the care manager (CM), the lynchpin of the collaborative care model. CMs are managing many more patients than recommended targets. Additionally, the unique context of the postpartum period, including newly competing priorities when managing demands of newborn care, often requires multiple outreach attempts by the CM to promote engagement. Due to these challenges, CMs are only able to complete the core CC tasks for women with critical mental health needs, leaving most women without the active management of care or brief behavioral interventions needed to achieve remission of depression. Technology-enabled services (TES), which use web-based and mobile application supported by low-intensity coaching or care-management, represent a novel solution that would enable the CMs to more efficiently and effectively adhere to the core tenants of collaborative care that have been demonstrated to improve depression outcomes. This research project will use a comprehensive user centered design approach to engage patients, care managers (CMs) and physicians in the design of a TES?comprised of technologies, CM service protocol, and implementation plan?that can be successfully deployed in a postpartum collaborative care program. The overall TES will be designed to support the existing collaborative care model, facilitating the acquisition of ongoing depression symptom tracking from patients and improving communication with patients, both critical to informing the stepped care processes. The design innovation focus of this research project will be to design a CM dashboard that will help organize the CM workflow, promote patient engagement, facilitate communication, and automate tasks. We will leverage ongoing research efforts in our Center developing CM dashboards that help CMs better organize their work. Patient-facing tools will focus on completing psychological assessments and receiving feedback. The effectiveness and implementation of the developed TES will be evaluated in a stepped wedge cluster randomized trial across 5 perinatal clinics. This project has the potential to create and assess implementation the first fully functional TES for postpartum collaborative care.
This project will design a technology-enabled service (TES) aimed at supporting collaborative care services for postpartum depression. The TES will contain a care manager dashboard to organize workflow, facilitate communication, and promote patient engagement and patient tools to support psychological assessments and dissemination of feedback. The TES will be evaluated using optimization-efficacy-implementation hybrid trial methodology, yielding results that will directly influence implementation practices for perinatal collaborative care nationwide.
