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The clinical performance and cost-effectiveness of two psychosocial assessment models in maternity care: The Perinatal Integrated Psychosocial Assessment study
Institution:1. National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health and School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, 2052 Australia;2. Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, NSW 2522, Australia;3. Perinatal and Women’s Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood NSW 2134, Australia;4. School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia;5. Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia;6. Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW 2006, Australia;7. School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney 2052, Australia;8. Faculty of Nursing, University of Calgary, 2500 University Drive, NW, University of Calgary, Calgary, AB T2N 1N4, Canada;9. Royal Hospital for Women, Sydney, Barker Street, Randwick, NSW 2031, Australia
Abstract:ProblemAlthough perinatal universal depression and psychosocial assessment is recommended in Australia, its clinical performance and cost-effectiveness remain uncertain.AimTo compare the performance and cost-effectiveness of two models of psychosocial assessment: Usual-Care and Perinatal Integrated Psychosocial Assessment (PIPA).MethodsWomen attending their first antenatal visit were prospectively recruited to this cohort study. Endorsement of significant depressive symptoms or psychosocial risk generated an ‘at-risk’ flag identifying those needing referral to the Triage Committee. Based on its detailed algorithm, a higher threshold of risk was required to trigger the ‘at-risk’ flag for PIPA than for Usual-Care. Each model’s performance was evaluated using the midwife’s agreement with the ‘at-risk’ flag as the reference standard. Cost-effectiveness was limited to the identification of True Positive and False Positive cases. Staffing costs associated with administering each screening model were quantified using a bottom-up time-in-motion approach.FindingsBoth models performed well at identifying ‘at-risk’ women (sensitivity: Usual-Care 0.82 versus PIPA 0.78). However, the PIPA model was more effective at eliminating False Positives and correctly identifying ‘at-risk’ women (Positive Predictive Value: PIPA 0.69 versus Usual Care 0.41). PIPA was associated with small incremental savings for both True Positives detected and False Positives averted.DiscussionOverall PIPA performed better than Usual-Care as a psychosocial screening model and was a cost-saving and relatively effective approach for detecting True Positives and averting False Positives. These initial findings warrant evaluation of longer-term costs and outcomes of women identified by the models as ‘at-risk’ and ‘not at-risk’ of perinatal psychosocial morbidity.
Keywords:Pregnancy  Psychosocial assessment  Depression screening  Cost-effectiveness
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