Abstract
Introduction/Objectives
This study examined factors affecting implementation of a primary care team expansion designed to improve timely diagnosis of causes of new anemia. This intervention introduced nurse navigators, who enrolled eligible patients and coordinated follow-up testing, and a clinical pathologist, who provided diagnostic interpretations to primary care providers.
Methods
Patients were enrolled between December 2023 and December 2025 across 12 primary care clinics using a cluster randomized stepped-wedge design. We measured implementation through administrative data and interviews with 90 clinic staff prior to and 3 months into implementation at each clinic.
Results
Personalized outreach improved provider participation. Simplified enrollment improved patient participation. Approximately 70% of patients got follow-up blood draws. Providers were sometimes unclear about the new workflow but also viewed the expanded team as an improvement which fit how they preferred to communicate with patients and was easy to implement.
Conclusions
This study found that a new primary care team process could be facilitated through a combination of personal outreach and efficiency, and that monitoring implementation revealed opportunities to enhance provider and patient engagement. Subsequent reporting will address the effects of this process on rates of timely anemia diagnosis. The trial registry name is 'A New Combination of Evidence-Based Interventions to Improve Primary Care Diagnostic Safety and Efficiency' and the URL is
https://clinicaltrials.gov/study/NCT05735314
.