Mourad S M, Nelen W L D M, Hermens R P M G, Bancsi L F, Braat D D M, Zielhuis G A, Grol R P T M, Kremer J A M
Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Hum Reprod. 2008 Nov;23(11):2493-500. doi: 10.1093/humrep/den281. Epub 2008 Jul 24.
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.
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.
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%).
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.
约30%-40%的患者未接受基于现有科学证据的治疗。对于不孕症，这可能意味着进行了不必要且昂贵的诊断测试和治疗。因此，通过监测当前的不孕症治疗来识别治疗过程中的差距很重要。此前已为此目的制定了一套基于39项指南的性能指标。本研究旨在评估该指标集的几个质量标准，并使用该指标集评估当前的不孕症治疗情况。
在16家荷兰不孕症诊所进行了一项历史性队列研究；邀请了2698对夫妇参与。指标数据通过病历提取、患者和专业人员问卷收集。评估了每个指标的质量标准（可测量性、可靠性、适用性、改进潜力、区分能力、复杂性和病例组合稳定性）。当前的治疗情况通过对各个指标的依从性来衡量。
1499对（56%）夫妇参与了研究。所有指标均可测量，但其他质量标准的结果各不相同。39项指标中共有14项的依从率低于50%。各诊所之间的治疗表现差异高达100%。在“IVF治疗指征”指南中，依从率中位数最高（86%）。在“生育力初始评估”指南中，依从率中位数最低（43%），紧随其后的是“无排卵”指南（44%）。
本研究显示了所制定的用于监测临床不孕症治疗的指标集的质量。在荷兰进行的首次评估显示，各诊所之间存在很大差异，且治疗改进空间很大。
