Minnesota Department of Human Services Uses AHRQ Evidence Report to Guide Policy Decision for Pregnant Women
The Minnesota Department of Human Services used AHRQ's Evidence Report/Technology Assessment No. 179, "Maternal and Neonatal Outcomes of Elective Induction of Labor," to establish a State statute that requires hospitals treating Medicaid mothers and infants to institute a clinical policy discouraging the use of elective induction of labor prior to 39 weeks' gestation in the absence of a clear medical need. The goal of reducing elective induction grew out of initial State efforts to improve health outcomes for mothers and infants and reduce costs by encouraging vaginal birth over elective cesarean delivery.
AHRQ's evidence report summarizes the clinical evidence comparing the safety and outcomes of elective cesarean delivery versus planned vaginal delivery. This research review identifies gaps in the existing research, highlights a need for consensus regarding terminology for both types of birth, and encourages further research.
Working with providers, the Minnesota Department of Human Services used AHRQ's evidence report to develop a State statute that requires providers to decrease elective inductions beyond 39 weeks' gestation for patients covered under the Medicaid program. The statute includes: having hospitals develop policies that prohibit the use of elective induction without medical indication for pregnancies at less than 39 weeks' gestation; the development of a quality review process for elective induction; having hospitals identify gestational age by 20 weeks' gestation for mothers who present for prenatal care and inform expectant mothers of the risks of early-term induction; and encouraging the medical community to make patient education regarding the risks of early-term induction a priority.
Jeff Schiff, MD, MBA, Medical Director with Minnesota Health Care Programs, notes, "We've received positive responses from small and large hospitals. These hospitals have seen a decrease in the need to resuscitate babies. Nurse anesthetists are not called as often and fewer babies are going to neonatal intensive care units. While it was hard to start these conversations at some sites, the hospital association has been supportive of this statewide effort to improve birth outcomes."
Since the legislation went into effect in January 2012, 95 percent of Minnesota births have taken place in hospitals that adopted this policy. Schiff conservatively estimates that this change has resulted in a savings of approximately $2 million in neonatal intensive care costs alone.
Maternal and Neonatal Outcomes of Elective Induction of Labor. March 2009. Evidence Report/Technology Assessment No. 179. AHRQ Publication No. 09-E005. Agency for Healthcare Research and Quality, Rockville, MD. Contract No. 290-02-0017. http://www.ahrq.gov/clinic/tp/cesarreqtp.htm