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Hum. Reprod. Advance Access originally published online on July 24, 2008
Human Reproduction 2008 23(11):2493-2500; doi:10.1093/humrep/den281
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Variation in subfertility care measured by guideline-based performance indicators

S.M. Mourad1,2, W.L.D.M. Nelen1, R.P.M.G. Hermens2, L.F. Bancsi3, D.D.M. Braat1, G.A. Zielhuis4, R.P.T.M. Grol2 and J.A.M. Kremer1,5

1 Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands 2 Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands 3 Department of Obstetrics and Gynaecology, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, The Netherlands 4 Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands

5 Correspondence address. E-mail: j.kremer{at}obgyn.umcn.nl

BACKGROUND: About 30–40% of patients do not receive care based on available scientific evidence. For subfertility, this may imply unnecessary and expensive diagnostic tests and treatments. It is therefore important to identify gaps in performance by monitoring current subfertility care. A set of 39 guideline-based performance indicators was previously developed for this purpose. This study aimed to assess several quality criteria of the indicator-set and to use the set to assess current subfertility care.

METHODS: A historic cohort study was performed in 16 Dutch subfertility clinics; 2698 couples were invited to participate. Indicator data were gathered by medical record extraction, and patient and professional questionnaires. Quality criteria for each indicator (measurability, reliability, applicability, improvement potential, discriminatory capacity, complexity and case-mix stability) were assessed. Current practice was measured as adherence to the separate indicators.

RESULTS: One thousand four-hundred and ninety-nine (56%) couples participated. All indicators were measurable, but the results for the other quality criteria varied. In total, 14 of the 39 indicators scored <50% adherence. Variation in performance between the clinics was up to 100%. The highest median adherence (86%) is found within the guideline ‘indications for IVF-treatment’. The lowest median adherence is found within the guideline ‘initial assessment of fertility’ (43%), followed closely by the guideline ‘anovulation’ (44%).

CONCLUSIONS: This study shows the quality of the developed indicator-set for monitoring clinical subfertility care. A first assessment in the Netherlands reveals large variation between clinics and ample room for improvement of care.

Key words: guidelines/performance indicator/monitoring/quality of care/subfertility

Submitted on March 25, 2008; resubmitted on June 19, 2008; accepted on June 25, 2008.


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