Hospital-Led Outreach to Reduce Anemia at Time of Delivery

By Amanda Jepson | Categories: | Comments Off on Hospital-Led Outreach to Reduce Anemia at Time of Delivery

Anemia in pregnancy increases the risk of needing a blood transfusion at the time of delivery threefold. It contributes to approximately 20 percent of severe maternal morbidity in historically marginalized groups. The transfusion rate at Natividad Medical Center, in Salinas, Calif., increased rapidly between 2021 and 2022, and anemia at the time of delivery had a prevalence of 18.8 percent of all births at Natividad. This problem was particularly evident in the Latina and Indigenous patient populations Natividad serves. Hospital leadership created this program to decrease the prevalence of anemia at the time of delivery and decrease Natividad’s transfusion rate.   

Natividad’s systemwide leadership, including community clinic leadership, collaborated to create a multi-pronged approach to diagnose and treat antepartum anemia rates. This program includes educating staff on the negative effect of anemia and how to monitor and treat iron deficiency, as well as monitoring patients’ hemoglobin and iron stores throughout pregnancy.  

Natividad created an infusion center to provide access to IV iron. Hospital leaders recognized that Medi-Cal only covered an iron infusion that required eight visits to infuse 1 gram of iron, which places a significant burden on patients that face transportation, financial, and time-related barriers to care. In response, Natividad collaborated with its Medicaid health maintenance organization to secure payment for single-dose IV treatments, increasing access to care.   

The chief of obstetrics at Natividad worked with medical leadership at the community clinics to develop best practices for the program, which led to robust evaluative efforts and peer-to-peer learning. From January 2023 to August 2024, the overall rate of anemia at participating clinics fell from 18.4 to 11.7 percent, while the anemia rate at nonparticipating clinics increased from 22.3 to 26.5 percent. In 2022, the Indigenous patient population had higher rates of anemia—20.6 percent, compared with 18.4 percent for non-Indigenous patients. By 2024, both groups had decreased anemia rates—12.1 percent for Indigenous patients and 11.6 percent for non-Indigenous patients—and the gap between rates closed.