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Hum. Reprod. Advance Access published online on February 16, 2007
Human Reproduction, doi:10.1093/humrep/dem018
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© The Author 2007. 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

Incorporating natural variation into IVF clinic league tables

Oscar Lemmers1, Jan A.M. Kremer2 and George F. Borm1,3

1 Department of Epidemiology and Biostatistics, 133 Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands 2 Department of Obstetrics and Gynaecology, 791 Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

3 To whom correspondence should be addressed at: Department of Epidemiology and Biostatistics, 133 Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Tel: +31 243617667; Fax: +31 243613505; E-mail: g.borm{at}epib.umcn.nl

BACKGROUND: More and more league tables are being published every day to rate the performance of health boards, hospitals and surgeons. However, they do not show the magnitude of uncertainty caused by natural variation.

METHODS: We propose a new method to present league tables in which the ratings are easy to interpret. Instead of just giving one score, we suggest the addition of best-case scenario and worst-case scenario scores. The true performance of a clinic, accounting for natural variation, is most likely to be between the best-case scenario and the worst-case scenario for its rating. These ratings can be computed easily, without any special software.

RESULTS: We illustrate our method based on data of Dutch IVF clinics from 2004. Six (out of 13) clinics shared a ‘top of the league’ position when considering the best-case scenario.

CONCLUSION: There is great uncertainty about the ratings. To show the magnitude of uncertainty, league tables should include the best-case scenario and the worst-case scenario ratings of each clinic.

Key words: IVF/league tables/outcome assessment/quality of care

Submitted on August 3, 2006; resubmitted on December 19, 2006; accepted on January 11, 2007.


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