(306) Assessing the impact of digital patient navigation tool for antepartum anemia: a hybrid effectiveness-implementation trial

Objective: While intravenous iron infusions (IVFe) are safe and effective in pregnancy, < 50% of patients with severe iron deficiency anemia (IDA) receive a dose. Here we evaluated the impact of prospectively implementing a digital patient navigation tool for IDA on clinical and patient-reported outcomes.

Study Design: This type 1 hybrid effectiveness implementation trial utilized difference-in-differences (DiD) design to compare the pre- and post-implementation outcomes at an intervention site to a control site. The digital navigation tool, designed using a multi-phase qualitative, patient-centered approach, included logistics, education, and treatment mapping (Figure). While all patients with antepartum IDA could use the tool starting in the 1^st trimester, only patients with severe IDA (3^rd trimester Hgb < 9.5g/dL) were institutionally eligible for IVFe and thus included in this analysis. The dual primary outcomes were completion of at least 1 IVFe and perceived health competence (validated 8-item survey, score 0-5). Multivariable logistic and linear regression models controlled for differences within sites over time, using interaction terms to estimate DiD. Implementation outcomes included initial use of the tool and continued tool engagement.

Results: 378 patients were included in the study. In-group differences were noted in hypertension history and insurance status over time. While completion of IVFe increased at both sites (66% to 84% of patients at the intervention site vs 78% to 83% at the control site), there was no statistical difference between these increases (DiD 0.12, p-value 0.26; Table). Perceived health competence remained similar at both sites (DiD 0.15, p-value 0.21). There were no significant differences in secondary outcomes. 66% (n=229) of eligible patients enrolled in the tool, but, of those, only 30% (n=71) accessed the tool more than once.

Conclusion: While implementation of a digital patient navigation tool for IDA increased IVFe completion by 18%, this result was not significant. Future work optimizing continued tool engagement may further improve clinical outcomes.