title: Trends in elective labor induction for six United States health plans, 2001-2007.
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.
authors.affiliation: 1 Group Health Research Institute , Seattle, Washingon.
authors.forename: Sascha
authors.initials: S
authors.lastname: Dublin
authors.forename: Karin E
authors.initials: KE
authors.lastname: Johnson
authors.forename: Rod L
authors.initials: RL
authors.lastname: Walker
authors.forename: Lyndsay A
authors.initials: LA
authors.lastname: Avalos
authors.forename: Susan E
authors.initials: SE
authors.lastname: Andrade
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Beaton
authors.forename: Robert L
authors.initials: RL
authors.lastname: Davis
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Herrinton
authors.forename: Pamala A
authors.initials: PA
authors.lastname: Pawloski
authors.forename: Marsha A
authors.initials: MA
authors.lastname: Raebel
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
authors.forename: Sengwee
authors.initials: S
authors.lastname: Toh
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000706:statistics & numerical data / Q000639:trends*; D007751:Labor, Induced / Q000706:statistics & numerical data / Q000639:trends*; D008499:Medical Records / Q000706:statistics & numerical data*; D007744:Obstetric Labor Complications / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D015995:Prevalence; D058996:Quality Improvement; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D016387:Women's Health / Q000639:trends*