Abstract
Objective
Iron deficiency anemia (IDA) is associated with adverse maternal and neonatal outcomes.
Patient navigation tools have improved treatment and surveillance completion among
postpartum populations. Our study aimed to evaluate the impact of prospectively implementing
a digital patient navigation tool for IDA in prenatal care (PN-IDA).
Study Design
This pilot type 1 hybrid effectiveness-implementation trial utilized a difference-in-differences
(DiD) design to compare pre- and postimplementation outcomes at an intervention site
to a control site. The trial was performed at a tertiary academic center in the northeastern
United States between April 2023 and April 2024. Patients with third-trimester Hgb < 9.5 g/dL
were institutionally eligible for IV iron (IVFe) and included in this analysis. Dual
primary outcomes were completion of ≥ 1 IVFe infusion and perceived health competence
(validated eight-item survey). Implementation outcomes assessed penetration and fidelity.
Multivariable logistical and linear regression models controlling for differences
in site characteristics over time used interaction terms to estimate DiD.
Results
Three hundred and seventy-eight patients were included. While IVFe completion increased
at both sites (66–84% at the intervention site vs. 78–83% at the control site), there
was no statistically significant difference (DiD RR: 1.13, 95% CI: 0.91–1.38). Perceived
health competence remained similar at both sites (median score: 3.3–3.3 at the intervention
site vs. median score: 3.3–3.1 at the control site, DiD RR: 0.15, 95% CI: −0.08 to
0.38). PN-IDA had a high level of penetration (i.e., integration of practice within
a service setting), but poor fidelity (i.e., degree to which an intervention is delivered
as intended). Sixty-six percent of eligible patients enrolled, but only 24% accessed
PN-IDA more than once.
Conclusion
PN-IDA implementation increased IVFe completion by 18% at the intervention site, but
our study was underpowered to assess this difference. Future work will refine PN-IDA
to optimize fidelity.
Key Points
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Completion of > 1 infusion increased by 18% at the intervention versus 5% at the control
site (95% CI: 0.91–1.38).
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Two-thirds of eligible patients enrolled in the tool.
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Only 24% of enrolled patients accessed the tool > 1 time.
Keywords
implementation science - patient navigation - iron deficiency anemia - pregnancy -
health services research
