OBJECTIVE: 

To evaluate whether perinatal collaborative care model implementation was associated with a reduction in racial disparities in depression care.

METHODS: 

This retrospective cohort study included pregnant and postpartum people who self-identified as either Black or White, and received prenatal care at academic faculty offices affiliated with an urban quaternary medical center. Individuals were divided into two cohorts to reflect the epochs of implementation. The primary outcome was the frequency of depression screening. The secondary outcome was the frequency of provision of a treatment recommendation for those with a positive depression screen. Antenatal and postpartum care were analyzed separately. A propensity score was used in multivariable models to control for confounders chosen a priori across implementation epoch. Interaction terms were created between race and implementation epoch to identify whether effect modification was present. Subgroup analyses were performed for outcomes with significant race-by-epoch interaction terms.

RESULTS: 

Of the 4,710 individuals included in these analyses, 4,135 (87.8%) self-identified as White and 575 (12.2%) self-identified as Black. Before implementation, Black individuals were more likely to receive screening (adjusted odds ratio [aOR] 2.44) but less likely to have a treatment recommended when a positive screen was identified (aOR 0.05). In multivariable models, race-by-epoch interaction terms were significant for both antenatal screening (P<.001) and antenatal treatment recommendation (P=.045), demonstrating that implementation of the perinatal collaborative care model was associated with reductions in extant racial disparities. After implementation, there were no significant differences by race (referent=White) in screening for antenatal depression (aOR 1.22, 95% CI 0.89–1.68) or treatment recommendations for those who screened positive (aOR 0.64, 95% CI 0.27–1.53). Race-by-epoch interaction terms were not significant in multivariable models for either postpartum screening or treatment recommendation.

CONCLUSION: 

Implementation of the perinatal collaborative care model is associated with a mitigation of racial disparities in antenatal depression care and may be an equity-promoting intervention for maternal health.

中文翻译：

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协作护理模式的实施与围产期抑郁症护理差异之间的关联

客观的： 

评估围产期协作护理模式的实施是否与抑郁症护理种族差异的减少有关。

方法： 

这项回顾性队列研究包括自我认定为黑人或白人的孕妇和产后人群，并在城市四级医疗中心附属的学术教职办公室接受产前护理。个人被分为两组以反映实施的时代。主要结果是抑郁症筛查的频率。次要结果是为抑郁症筛查呈阳性的患者提供治疗建议的频率。产前和产后护理分别进行分析。在多变量模型中使用倾向评分来控制在实施时期先验选择的混杂因素。在竞赛和实施时期之间创建了交互项，以确定是否存在效果修改。对具有显着的逐个时期交互项的结果进行亚组分析。

结果： 

在这些分析中纳入的 4,710 人中，有 4,135 人 (87.8%) 自认为是白人，575 人 (12.2%) 自认为是黑人。在实施之前，黑人更有可能接受筛查（调整后的比值比 [aOR] 2.44），但在筛查呈阳性时不太可能接受推荐治疗（aOR 0.05）。在多变量模型中，按种族划分的交互项对于产前筛查 ( P <.001) 和产前治疗建议 ( P =.045) 均显着，表明围产期协作护理模式的实施与现有种族的减少相关。差异。实施后，在产前抑郁症筛查（aOR 1.22，95% CI 0.89–1.68）或筛查阳性者的治疗建议（aOR 0.64，95% CI 0.27–1.53）方面，种族（参考=白人）没有显着差异。 。在产后筛查或治疗建议的多变量模型中，种族与时期的相互作用项并不显着。

结论： 

围产期协作护理模式的实施与缓解产前抑郁症护理中的种族差异有关，并且可能是促进孕产妇健康公平的干预措施。