Evidence map›Paper›PMID 33493705›Full record

ArticleAmerican journal of obstetrics & gynecology MFM2021

Implementation of a calculator to predict cesarean delivery during labor induction: a qualitative evaluation of the clinician perspective.

Rebecca F Hamm, Lisa D Levine, Maria N Nelson, Rinad Beidas

Registry-linked trialAbstract read
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In one paragraph

Article in American journal of obstetrics & gynecology MFM, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06576323 (An Intervention Mapping Approach to Closing the Gap in Maternal OUD and Infant NAS Care), which is not on this map. Cited by 3 papers.

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0cells of the map it votes in
3citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06576323 narecruitingnot on this mapstarted 2024, after this paper: background citation

An Intervention Mapping Approach to Closing the Gap in Maternal OUD and Infant NAS Care

TypeinterventionalSponsorUniversity of PennsylvaniaRan2024 to 2027Enrolled50ConditionsOpioid Use Disorder, Neonatal Abstinence SyndromeArmsAn implementation model for co-located Medications for Opioid Use Disorder (MOUD) prescription in the NICU
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Rebecca F HammMaternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Drs Hamm and Levine). Electronic address: Rebecca.feldmanhamm@uphs.upenn.edu.
Lisa D LevineMaternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Drs Hamm and Levine).
Maria N NelsonMixed Methods Research Lab, University of Pennsylvania, Philadelphia, PA (Ms Nelson).
Rinad BeidasDepartments of Psychiatry, Medical Ethics and Health Policy, and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr Beidas); Penn Implementation Science Center (PISCE@LDI), Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (Dr Beidas).

Funding

A standardized labor induction protocol to reduce primary cesarean and racial disparities in labor outcomes: a prospective cohort studyK23HD102523 · NICHD · UNIVERSITY OF PENNSYLVANIA · PI HAMM, REBECCA FELDMAN · 2020 to 2023
$680k
NICHD NIH HHS K23 HD102523
6 · The paper itself

Abstract

backgroundWe previously conducted a prospective cohort study (n=1610) demonstrating that the implementation of a validated calculator to predict likelihood of cesarean delivery during labor induction was associated with reduced maternal morbidity, reduced cesarean delivery rate, and improved birth satisfaction.

objectiveTo optimize future implementation, we used qualitative interviews to understand the clinician perspective on: (1) the cesarean delivery risk calculator implementation and (2) the mechanisms by which the use of the calculator resulted in the observed improved outcomes. STUDY

designAfter completion of the prospective study (June 30, 2019), 20 trainees and attending clinicians (including nurse-midwives, obstetrical physicians, and family medicine physicians) at the study site participated in a single, brief semistructured interview from March 1, 2020, to June 30, 2020. Transcriptions were coded using a systematic approach.

resultsOverall, clinicians had favorable perspectives regarding the cesarean delivery risk calculator. Clinicians described the calculator as offering "objective data" and a "standardized snapshot of the labor trajectory." Concerns were raised regarding "overreliance" on calculator output. Barriers to use included time for patient counseling and "awkwardness" around the interactions and perceived patient misunderstanding of the calculator result. Although most senior clinicians (n=8) reported that the calculator did not impact patient management, trainee clinicians (n=12) more often felt that the calculator influenced care at the extremes of cesarean delivery risk. Furthermore, more senior clinicians felt "neutral" regarding any impact of counseling patients on cesarean delivery risk compared with trainee clinicians, who felt that the counseling "built [patient-clinician] trust."

conclusionThis qualitative evaluation characterized the generally positive clinician perspective around the cesarean delivery risk calculator, while identifying specific facilitators and barriers to implementation. In addition, we elucidated potential mechanisms by which the calculator may have been related to clinician decision making and patient-clinician interactions, leading to reduced maternal morbidity and improved patient birth satisfaction. This information is important as widespread implementation of the cesarean delivery risk calculator begins.

Indexed as

Labor, ObstetricNurse MidwivesCesarean SectionFemaleHumansLabor, InducedPregnancyProspective Studiesbarriersbirth satisfactioncalculatorcesarean delivery ratecesarean delivery riskfacilitatorsimplementationmaternal morbidityqualitative methods

Identifiers

PMID33493705
PMCPMC8144058

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.