{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:47:42Z","timestamp":1791863262793,"version":"4.3.4"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100016783","name":"University of Pennsylvania Health System","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016783","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01HD113618"],"award-info":[{"award-number":["R01HD113618"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Learning Health Systems"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Our group developed a calculator to predict individualized likelihood of cesarean delivery for patients undergoing labor induction. We aimed to determine whether nudge theory informed EHR integration of the cesarean risk calculator would increase (1) calculator utilization, and (2) documentation of patient counseling on the result.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a prospective cohort comparing 6\u2009months pre (10\/2022\u20134\/2023) versus 6\u2009months post EHR\u2010release of the cesarean risk calculator (4\/2023\u201310\/2023) in two labor units. Prior to EHR\u2010integration, Site #1 had a 2018 focused effort towards calculator website use, while Site #2 had no previous use. EHR\u2010integration was automated to recognize eligible patients and allowed clinicians to confirm and utilize EHR variables for score automation, visible on electronic display. Counseling recommendations, specific to the patient's cesarean risk level, were then available for insertion into an EHR\u2010note. The primary outcomes were (1) calculator utilization measured as a score generated in the EHR and (2) risk counseling defined as documentation of score discussion with the patient. The primary outcomes were also analyzed stratified by site.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 2018 patients met eligibility criteria for the cesarean risk calculator (pre:998; post:1010). Clinician calculator utilization significantly increased POST\u2010EHR implementation from 13.4% to 77.4% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Site #2, without a prior effort towards calculator use, had greater increase in use with EHR integration compared to Site #1 (Site#1 pre: 28.8% vs. post: 62.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; Site#2 pre: 0.4% vs. post: 91.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Documentation of patient counseling also increased overall (4.0% vs. 9.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001); when stratified by site, this difference was only seen at Site #2.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Behaviorally designed EHR integration of a cesarean risk calculator for labor induction was associated with significant increases in calculator utilization and documentation of patient counseling. This model could be applied to other evidence\u2010based health\u2010related risk calculators.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lrh2.70120","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T02:40:48Z","timestamp":1791859248000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Electronic Health Record Integration of a Calculator for Cesarean Risk During Labor Induction"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2587-2054","authenticated-orcid":false,"given":"Rebecca F.","family":"Hamm","sequence":"first","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"},{"name":"Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia PA  Fairfax Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5747-2606","authenticated-orcid":false,"given":"M. Corinne","family":"Steele","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5959-1659","authenticated-orcid":false,"given":"Sameh","family":"Saleh","sequence":"additional","affiliation":[{"name":"Inova Health System  Fairfax Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Epps","sequence":"additional","affiliation":[{"name":"Penn Medicine Information Services University of Pennsylvania Health System  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2919-5929","authenticated-orcid":false,"given":"E. Madeline","family":"Grenader","sequence":"additional","affiliation":[{"name":"Penn Medicine Nudge Unit, Center for Health Care Transformation and Innovation, University of Pennsylvania Health System  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6811-7980","authenticated-orcid":false,"given":"Lisa D.","family":"Levine","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"},{"name":"Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Kit","family":"Delgado","sequence":"additional","affiliation":[{"name":"Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia PA  Fairfax Virginia USA"},{"name":"Penn Medicine Nudge Unit, Center for Health Care Transformation and Innovation, University of Pennsylvania Health System  Philadelphia Pennsylvania USA"},{"name":"Department of Emergency Medicine University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/NMC.0000000000001027"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2012.04.017"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2019.8187"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000157436.68847.3b"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/01443610120101637"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.11.603"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.25582"},{"key":"e_1_2_8_9_1","first-page":"1834","article-title":"Standardized Cesarean Risk Counseling With Induction: Impact on Racial Disparities in Birth Satisfaction","volume":"40","author":"Hamm R. 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