Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Sep 2;5(9):e008755.
doi: 10.1136/bmjopen-2015-008755.

Variation in hospital rates of induction of labour: a population-based record linkage study

Tanya A Nippita  1 , Judy A Trevena  2 , Jillian A Patterson  3 , Jane B Ford  3 , Jonathan M Morris  3 , Christine L Roberts  3
Affiliations

Variation in hospital rates of induction of labour: a population-based record linkage study

Tanya A Nippita et al. BMJ Open. .

Abstract

Objectives: To examine interhospital variation in rates of induction of labour (IOL) to identify potential targets to reduce high rates of practice variation.

Design: Population-based record linkage cohort study.

Setting: New South Wales, Australia, 2010-2011.

Participants: All women with live births of ≥24 weeks gestation in 72 hospitals.

Primary outcome measure: Variation in hospital IOL rates adjusted for differences in case-mix, according to 10 mutually exclusive groups derived from the Robson caesarean section classification; groups were categorised by parity, plurality, fetal presentation, prior caesarean section and gestational age.

Results: The overall IOL rate was 26.7% (46,922 of 175,444 maternities were induced), ranging from 9.7% to 41.2% (IQR 21.8-29.8%) between hospitals. Nulliparous and multiparous women at 39-40 weeks gestation with a singleton cephalic birth were the greatest contributors to the overall IOL rate (23.5% and 20.2% of all IOL respectively), and had persisting high unexplained variation after adjustment for case-mix (adjusted hospital IOL rates ranging from 11.8% to 44.9% and 7.1% to 40.5%, respectively). In contrast, there was little variation in interhospital IOL rates among multiparous women with a singleton cephalic birth at ≥41 weeks gestation, women with singleton non-cephalic pregnancies and women with multifetal pregnancies.

Conclusions: 7 of the 10 groups showed high or moderate unexplained variation in interhospital IOL rates, most pronounced for women at 39-40 weeks gestation with a singleton cephalic birth. Outcomes associated with divergent practice require determination, which may guide strategies to reduce practice variation.

Keywords: EPIDEMIOLOGY; OBSTETRICS.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Adjusted hospital-specific induction rates, separately for each induction group, NSW, 2010–2011 (hospitals ordered from lowest to highest rate). *Red line represents the state average rate for each induction group.(CS, caesarean section; IOL, induction of labour).
See this image and copyright information in PMC

References

    1. Glantz JC. Obstetric variation, intervention, and outcomes: doing more but accomplishing less. Birth 2012;39:286–90. 10.1111/birt.12002 - DOI - PubMed
    1. Corallo AN, Croxford R, Goodman DC et al. . A systematic review of medical practice variation in OECD countries. Health Policy 2014;114:5–14. 10.1016/j.healthpol.2013.08.002 - DOI - PubMed
    1. Mulley AG. Improving productivity in the NHS. BMJ 2010;341:c3965 10.1136/bmj.c3965 - DOI - PubMed
    1. Wennberg JE. Time to tackle unwarranted variations in practice. BMJ 2011;342:d1513 10.1136/bmj.d1513 - DOI - PubMed
    1. Ham C. Doctors must lead efforts to reduce waste and variation in practice. BMJ 2013;346:f3668 10.1136/bmj.f3668 - DOI - PubMed

Publication types