{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T13:26:49Z","timestamp":1750339609111,"version":"3.40.5"},"reference-count":53,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T00:00:00Z","timestamp":1676937600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015471","name":"Mater Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015471","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Implementation of pathways to screen surgical patients for preoperative anemia and iron deficiency remains limited. This study sought to measure the impact of a theoretically informed, bespoke change package on improving the uptake of a Preoperative Anemia and Iron Deficiency Screening, Evaluation, and Management Pathway.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design and Methods<\/jats:title><jats:p>Pre\u2010post interventional study using a type two hybrid\u2010effectiveness design evaluated implementation. Four hundred (400) patient medical record reviews provided the dataset (200 pre\u2010 and 200\u2010post implementation). The primary outcome measure was compliance with the pathway. Secondary outcome measures (clinical outcomes) were anemia on day of surgery, exposure to a red blood cell (RBC) transfusion, and hospital length of stay. Validated surveys facilitated data collection of implementation measures. Propensity score\u2010adjusted analyses determined the effect of the intervention on clinical outcomes, and a cost analysis determined the economic impact.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For the primary outcome, compliance improved significantly post\u2010implementation (Odds Ratio 10.6 [95% CI 4.4\u201325.5] <jats:italic>p<\/jats:italic>\u00a0&lt;\u2009.000). In secondary outcomes, adjusted analyses point estimates showed clinical outcomes were slightly improved for anemia on day of surgery (Odds Ratio 0.792 [95% CI 0.5\u20131.3] <jats:italic>p<\/jats:italic>\u00a0=\u2009.32), RBC transfusion (Odds Ratio 0.86 [95% CI 0.41\u20131.78] <jats:italic>p<\/jats:italic>\u00a0=\u2009.69) and hospital length of stay (Hazard Ratio 0.96 [95% CI 0.77\u20131.18] <jats:italic>p<\/jats:italic>\u00a0=\u2009.67), although these were not statistically significant. Cost savings of $13,340 per patient were realized. Implementation outcomes were favorable for acceptability, appropriateness, and feasibility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The change package significantly improved compliance. The absence of a statistically significant change in clinical outcomes may be because the study was powered to detect an improvement in compliance only. Further prospective studies with larger samples are needed. Cost savings of $13,340 per patient were achieved and the change package was viewed favorably.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.17287","type":"journal-article","created":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T16:18:11Z","timestamp":1676996291000},"page":"724-736","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Results from a type two hybrid\u2010effectiveness study to implement a preoperative anemia and iron deficiency screening, evaluation, and management pathway"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3931-2875","authenticated-orcid":false,"given":"Alana","family":"Delaforce","sequence":"first","affiliation":[{"name":"School of Nursing and Midwifery The University of Newcastle  Callaghan New South Wales Australia"},{"name":"Mater Health Services  South Brisbane Queensland Australia"},{"name":"Mater Research Institute\u2010UQ  South Brisbane 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