Opportunity

Maternal morbidity is a significant problem in the United States, occurring in about 15–20 percent of births. Labor induction and cesarean delivery, in particular, are associated with higher rates of adverse health conditions.

A Penn clinician developed a calculator to predict how likely cesarean delivery is for individuals undergoing labor induction. Use of this calculator, which can help guide decision-making, is linked to lower rates of maternal morbidity and cesarean delivery and a reduction in racial disparities in patient satisfaction.

Clinicians who wish to use the calculator presently face several barriers: They must recognize when a patient is eligible, navigate to an external website, and enter the patient’s information to obtain the risk calculation.

Intervention

We partnered with the PennChart team to build an automated tool in the electronic health record (EHR) that eliminates the major barriers to using the cesarean risk calculator. The tool identifies eligible patients, alerts OB-GYN and family medicine clinicians, performs the cesarean risk calculation, and provides clinical guidance according to the result.

Impact

Calculator usage increased from 13 percent to 77 percent across two Penn Medicine hospitals after we integrated this tool into the EHR workflow. The percentage of patients counseled on the risk, as measured in EHR-based documentation, also result rose significantly, from 4 to 10 percent. 

We are currently evaluating the impact of our intervention on cesarean delivery and maternal and infant morbidity. The research team is also scaling this effort with support from an NIH R01 grant, implementing the EHR-embedded calculator across 14 labor and delivery units at multiple health systems. Finally, the EHR vendor Epic is making the build available to health care organizations across the United States.