American journal of perinatology · 2025
Assessing the Impact of a Digital Patient Navigation Tool for Iron Deficiency Anemia in Pregnancy: A Hybrid Effectiveness-Implementation Trial.
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Kumar Natasha R, Butt Zoya, Calcei Jonathan B, Forkpa Markolline, Mumford Sunni, Levine Lisa D, Hamm Rebecca F
Аннотация
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: · Completion of > 1 infusion increased by 18% at the intervention versus 5% at the control site (95% CI: 0.91-1.38).. · Two-thirds of eligible patients enrolled in the tool.. · Only 24% of enrolled patients accessed the tool > 1 time..
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: · Completion of > 1 infusion increased by 18% at the intervention versus 5% at the control site (95% CI: 0.91-1.38).. · Two-thirds of eligible patients enrolled in the tool.. · Only 24% of enrolled patients accessed the tool > 1 time..