Patient Centered Community and Clinical Approaches to Reduce Racial Disparities at Birth by Preventing Anemia

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Project Summary/Abstract: Project 1 Iron deficiency anemia (IDA) affects up to one-third of people during pregnancy, with Black and Hispanic/Latina people experiencing the highest rates. IDA is a condition of too little iron in the body, resulting in too few healthy red blood cells, which puts pregnant people at risk for postpartum hemorrhage (PPH; excessive bleeding after childbirth) and related severe maternal morbidity (SMM). IDA is preventable, but current approaches to prevention and treatment are not working. The incidence of IDA during pregnancy is increasing, the disparities are worsening, and patient perspectives are lacking. Rates of IDA at birth admission, the time of greatest maternal risk, are up to 3-4x higher among Black pregnant people compared to White pregnant people and 1.5-2x higher among Latinx pregnant people. The goal of this project is to increase hemoglobin (i.e., resolve anemia) at birth admission for all pregnant people, thereby reducing the racial/ethnic disparities in IDA and reducing anemia-related SMM from PPH. The objective of this project is to create a novel Anemia Prevention Toolkit (i.e., a set of patient- and community-centered guidelines and implementation strategies) and then implement and disseminate it at scale using collaborative quality improvement methods. The rationale underlying this work is that both clinicians, represented by the Clinical Collaborative Leadership Group, and community partners and people with lived experience of IDA, represented by the Anemia Community Leadership Group, desire the education and guidance of such a toolkit and are dedicated to working together to create, optimize, and implement it. We will achieve our goal by pursuing the following three Specific Aims: 1) develop an Anemia Prevention Toolkit that aligns evidence-based practice with patient- centered care, incorporating patients’ lived experience, community assets, and clinical/hospital workflows; 2) optimize the Toolkit to increase hemoglobin at birth admission by piloting it at 8 hospitals, and examine its acceptability and practicality; and 3) implement and disseminate the modified Toolkit across a network of more than 300 hospitals in CA, OR, and WA to reduce anemia and SMM from PPH. To pursue these aims, we will utilize a rigorous implementation science framework that combines patient-centered community perspectives with structured, evidence-based clinical care and education for anemia in pregnancy. Guided by the Pathways to Racial and Ethnic Disparities in SMM and Mortality Model, the project’s outcomes will prioritize patient and community experiences and input. Clinical and health system stakeholders and frontline staff will work together in alignment with the Public Health Critical Race Praxis, employing an iterative methodology to ensure attentiveness to equity throughout the project. This innovative approach holds the research team accountable to the patients and communities impacted by the significant problem of IDA during pregnancy—establishing community partners as project co-leads, adopting methods that require ongoing check-in with the community, and recognizing bias and structural racism as a factor that contributes to health disparities in IDA.