Trends in elective labor induction for six United States Health Plans, 2001-2007

Sascha Dublin, Karin E. Johnson, Rod L. Walker, Lyndsay A. Avalos, Susan E. Andrade, Sarah J. Beaton, Robert Davis, Lisa J. Herrinton, Pamala A. Pawloski, Marsha A. Raebel, David H. Smith, Sengwee Toh, Aaron B. Caughey

Research output: Contribution to journalReview article

12 Citations (Scopus)

Abstract

Background: To describe trends in labor induction, including elective induction, from 2001 to 2007 for six U.S. health plans and to examine the validity of induction measures derived from birth certificate and health plan data. Methods: This retrospective cohort study included 339,123 deliveries at 35 weeks' gestation or greater. Linked health plan and birth certificate data provided information about induction, maternal medical conditions, and pregnancy complications. Induction was defined from diagnosis and procedure codes and birth certificate data and considered elective if no accepted indication was coded. We calculated induction prevalence across health plans and years. At four health plans, we reviewed medical records to validate induction measures. Results: Based on electronic data, induction prevalence rose from 28% in 2001 to 32% in 2005, then declined to 29% in 2007. The trend was driven by changes in the prevalence of apparent elective induction, which rose from 11% in 2001 to 14% in 2005 and then declined to 11% in 2007. The trend was similar for subgroups by parity and gestational age. Elective induction prevalence varied considerably across plans. On review of 86 records, 36% of apparent elective inductions identified from electronic data were confirmed as valid. Conclusions: Elective induction appeared to peak in 2005 and then decline. The decrease may reflect quality improvement initiatives or changes in policies, patient or provider attitudes, or coding practices. The low validation rate for measures of elective induction defined from electronic data has important implications for existing quality measures and for research studies examining induction's outcomes.

Original languageEnglish (US)
Pages (from-to)904-911
Number of pages8
JournalJournal of Women's Health
Volume23
Issue number11
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

Fingerprint

State Health Plans
Induced Labor
Birth Certificates
Health
Pregnancy Complications
Quality Improvement
Parity
Gestational Age
Medical Records
Cohort Studies
Retrospective Studies
Mothers
Pregnancy
Research

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Dublin, S., Johnson, K. E., Walker, R. L., Avalos, L. A., Andrade, S. E., Beaton, S. J., ... Caughey, A. B. (2014). Trends in elective labor induction for six United States Health Plans, 2001-2007. Journal of Women's Health, 23(11), 904-911. https://doi.org/10.1089/jwh.2014.4779

Trends in elective labor induction for six United States Health Plans, 2001-2007. / Dublin, Sascha; Johnson, Karin E.; Walker, Rod L.; Avalos, Lyndsay A.; Andrade, Susan E.; Beaton, Sarah J.; Davis, Robert; Herrinton, Lisa J.; Pawloski, Pamala A.; Raebel, Marsha A.; Smith, David H.; Toh, Sengwee; Caughey, Aaron B.

In: Journal of Women's Health, Vol. 23, No. 11, 01.11.2014, p. 904-911.

Research output: Contribution to journalReview article

Dublin, S, Johnson, KE, Walker, RL, Avalos, LA, Andrade, SE, Beaton, SJ, Davis, R, Herrinton, LJ, Pawloski, PA, Raebel, MA, Smith, DH, Toh, S & Caughey, AB 2014, 'Trends in elective labor induction for six United States Health Plans, 2001-2007', Journal of Women's Health, vol. 23, no. 11, pp. 904-911. https://doi.org/10.1089/jwh.2014.4779
Dublin S, Johnson KE, Walker RL, Avalos LA, Andrade SE, Beaton SJ et al. Trends in elective labor induction for six United States Health Plans, 2001-2007. Journal of Women's Health. 2014 Nov 1;23(11):904-911. https://doi.org/10.1089/jwh.2014.4779
Dublin, Sascha ; Johnson, Karin E. ; Walker, Rod L. ; Avalos, Lyndsay A. ; Andrade, Susan E. ; Beaton, Sarah J. ; Davis, Robert ; Herrinton, Lisa J. ; Pawloski, Pamala A. ; Raebel, Marsha A. ; Smith, David H. ; Toh, Sengwee ; Caughey, Aaron B. / Trends in elective labor induction for six United States Health Plans, 2001-2007. In: Journal of Women's Health. 2014 ; Vol. 23, No. 11. pp. 904-911.
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abstract = "Background: To describe trends in labor induction, including elective induction, from 2001 to 2007 for six U.S. health plans and to examine the validity of induction measures derived from birth certificate and health plan data. Methods: This retrospective cohort study included 339,123 deliveries at 35 weeks' gestation or greater. Linked health plan and birth certificate data provided information about induction, maternal medical conditions, and pregnancy complications. Induction was defined from diagnosis and procedure codes and birth certificate data and considered elective if no accepted indication was coded. We calculated induction prevalence across health plans and years. At four health plans, we reviewed medical records to validate induction measures. Results: Based on electronic data, induction prevalence rose from 28{\%} in 2001 to 32{\%} in 2005, then declined to 29{\%} in 2007. The trend was driven by changes in the prevalence of apparent elective induction, which rose from 11{\%} in 2001 to 14{\%} in 2005 and then declined to 11{\%} in 2007. The trend was similar for subgroups by parity and gestational age. Elective induction prevalence varied considerably across plans. On review of 86 records, 36{\%} of apparent elective inductions identified from electronic data were confirmed as valid. Conclusions: Elective induction appeared to peak in 2005 and then decline. The decrease may reflect quality improvement initiatives or changes in policies, patient or provider attitudes, or coding practices. The low validation rate for measures of elective induction defined from electronic data has important implications for existing quality measures and for research studies examining induction's outcomes.",
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