Call to Action – Closing the Gap to Make Patient Blood Management the New Norm(al) as Viewed by Implementors in Diverse Countries

Abstract

BackgroundMillions of hospitalized patients are anemic. However, anemia is an independent risk factor for adverse outcomes including morbidity and mortality. In combination with blood loss, anemia is the main driver for transfusion, thus adding risk for adverse outcomes. Patient Blood Management (PBM) is a concept to identify and correct anemia and to minimize blood loss. Evidence demonstrates that PBM significantly improves outcomes and safety while reducing cost by macroeconomic magnitudes. Despite its huge potential to improve healthcare systems, PBM is not yet adopted broadly. By gathering the experiences of a diverse group of PBM implementors across countries with different healthcare contexts, we aimed to identify the drivers, barriers, measures, and stakeholders regarding the implementation of PBM. The synthesis of this information should provide a matrix of complementary measures, allowing PBM stakeholders from diverse professional backgrounds to initiate and orchestrate PBM implementation.MethodsSemi-structured interviews were conducted with 1-4 PBM implementors from 12 countries in Asia, Latin America, Australia, Central and Eastern Europe, the Middle East, and Africa. Responses were summarized per country, and key observations extracted. By defining the levels of intervention for PBM implementation and applying the Donabedian Quality Framework, we created and populated a matrix of key measures and outcomes as identified from the interviews.ResultsWe were able to extract a set of structural and procedural PBM implementation measures from interviews with the implementors. We created a matrix addressing six levels of implementation including government, healthcare providers (HCP), funding, research, training/education and patients and identified structural and procedural measures on each level. ConclusionThis matrix helps to decompose the complexity of PBM implementation into concrete measures on each implementation level. It provides guidance for diverse stakeholders to independently initiate and develop strategies to make PBM a national standard of care, thus closing current practice gaps and matching this unmet public health need.