Ohio Medicaid Uses AHRQ Evidence Report to Guide Policy Decision for Women and Infants

Comparative Effectiveness
May 2012

Ohio Medicaid used AHRQ's evidence report, "Maternal and Neonatal Outcomes of Elective Induction of Labor" to refine clinical policy and improve health outcomes for Medicaid mothers and infants.

AHRQ's evidence report, which summarizes clinical evidence comparing the safety and outcomes of elective induction of labor with expectant management, found that there is an associated increase in cesarean deliveries when labor is induced compared with when labor occurs spontaneously.

Using the information provided in the report, in conjunction with applied expertise, Ohio Medicaid's Neonatal Transformation Team reduced the induction of labor without clear medical indication in near-term infants by 40 percent over an 18-month period in 20 maternity hospitals. This reduction equated to a shift of more than 8,300 infants from near term to full term, preventing nearly 200 neonatal intensive care unit admissions and some infant deaths, and resulting in a reduction in unplanned cesarean delivery rates.

"Reducing cesarean [deliveries] was not our primary intent, but reducing elective deliveries without clear medical indication did result in a modest reduction of those rates," notes Mary Applegate, MD, Medical Director of Ohio Medicaid. "AHRQ's resources on maternal and child health have been instrumental in assisting Ohio's Medicaid Neonatal Transformation Team with making decisions to improve infant health." The team also used the report for patient education.

Ohio Medicaid received a Medicaid Transformation Grant from the Centers for Medicare & Medicaid Services to improve the health outcomes for mothers and infants by implementing evidence-based practices in neonatal and obstetrical settings, developing partnerships, and sharing improvements. Ohio Medicaid participates in the Medicaid Medical Directors Learning Network, an AHRQ Knowledge Transfer project that provides a forum for clinical leaders of State Medicaid programs to discuss their most pressing needs as policymakers.

Impact Case Study Identifier: 
AHRQ Product(s): Effective Health Care Program, Medicaid Medical Directors Learning Network
Topics(s): Women's Health, Pediatrics
Geographic Location: Ohio
Implementer: Ohio Medicaid
Date: 05/01/2012

Caughey AB, Sundaram V, Kaimal AJ, et al. Maternal and Neonatal Outcomes of Elective Induction of Labor. Evidence Report/Technology Assessment No. 176. (Prepared by the Stanford University--University of California, San Francisco Evidence-based Practice Center under Contract No. 290-02-0017.) AHRQ Publication No. 09-E005. Rockville, MD: Agency for Healthcare Research and Quality; March 2009.

Page last reviewed October 2014