There’s the important care doctor who, unable to identify new details in daily notes, has begun printing them out and keeping two superimposed pages up to the light to discover what’s changed. I possibly could be younger. Physicians retiring early. Small methods bankrupted by up-front expenses or locked into ineffective systems by the prohibitive price of switching. Hours consumed by onerous data access unrelated to patient care. Workflow disruptions. And most importantly, massive intrusions on our individual relationships. These complaints might be dismissed as growing pains, born of resistance to change.Among the 16 hospitals in the intervention group, 12 fulfilled the prespecified criteria for adherence to the protocol. The primary reason for nonadherence was the absence of formal feedback supplied by the audit committee to local medical researchers. The per-protocol evaluation, which excluded the 4 nonadherent intervention hospitals, yielded a more marked intervention impact than the intention-to-treat analysis ; no significant heterogeneity across hospitals was found . Center-specific results are shown in Section 5 in the Supplementary Appendix. Secondary Outcomes There was a substantial but small difference between the intervention group and the control group with regards to the change in the rate of assisted vaginal delivery from the preintervention period to the postintervention period , and even though the rate of labor induction increased in both groups, there was a lesser upsurge in the intervention group .