RESUMEN
OBJECTIVE: To assess the association of patient and hospital characteristics with adherence to guidelines for intrauterine insemination (IUI) care. DESIGN: Retrospective cohort study using multilevel regression analysis. Characteristics studied at the patient level were female age, type and duration of subfertility, diagnosis and number of started IUI cycles. At the hospital level, the characteristics studied were hospital size, teaching hospital, in vitro fertilization (IVF) licence and number of physicians involved in the IUI programme. Data were obtained from medical records and questionnaires for gynaecologists. SETTING AND PARTICIPANTS: Five hundred and fifty-eight subfertile couples who underwent IUI treatment at 10 Dutch hospitals. MAIN OUTCOME MEASURES: Adherence to systematically developed guideline-based performance indicators describing 20 processes of IUI care. RESULTS: A total of 558 couples who started 2,334 IUI cycles participated. Guideline adherence in IUI care was often substandard and varied considerably between hospitals. Variation in guideline adherence in IUI care was associated with the patient characteristics 'diagnosis' and 'female age'. Only adherence to the guideline recommendation regarding 'screening for tubal occlusion' was associated with hospital characteristics ('hospital size' and 'IVF licence'). Large explained variances up to 39% were found for the different models. CONCLUSIONS: A number of patient and hospital characteristics were associated with variation in guideline adherence in IUI care, particularly the patient characteristics 'diagnosis' and 'female age'. The identification of different subgroups in the patient population and different types of hospitals with regard to the extent of guideline adherence in IUI care is important for the tailoring of interventions to improve IUI care.
Asunto(s)
Infertilidad Femenina/terapia , Infertilidad Masculina/terapia , Inseminación Artificial/normas , Adulto , Femenino , Adhesión a Directriz/estadística & datos numéricos , Encuestas de Atención de la Salud , Humanos , Infertilidad Femenina/clasificación , Infertilidad Femenina/etiología , Infertilidad Masculina/clasificación , Infertilidad Masculina/etiología , Masculino , Edad Materna , Registros Médicos , Persona de Mediana Edad , Países Bajos , Mejoramiento de la Calidad , Estudios Retrospectivos , Adulto JovenRESUMEN
Health-care delivery according to clinical practice guidelines is thought to be critical in achieving optimal outcomes. This study aimed to assess the extent to which practice performance in intrauterine insemination (IUI) care is consistent with guideline recommendations and to evaluate the association between guideline adherence and outcome of IUI care. In a retrospective cohort study, 1100 infertile couples who underwent IUI treatment at 10 Dutch hospitals were asked to grant access to their medical record for assessment of guideline adherence using 25 systematically developed guideline-based performance indicators. A total of 558 couples who started 2334 IUI cycles participated. Guideline adherence regarding 20 process and five structure aspects of IUI care was often substandard and varied considerably between hospitals. Out of 10 possible associations investigated, guideline adherence regarding sperm quality and guideline adherence regarding the total number of IUI cycles were associated with improved ongoing pregnancy rates after IUI. Thus, guideline adherence in IUI care is far from optimal and varies substantially between hospitals. As associations between guideline adherence and ongoing pregnancy after IUI were mainly non-significant, further research is needed to evaluate associations between guideline adherence and other outcomes of IUI care besides ongoing pregnancy, such as patient safety and cost effectiveness.
Asunto(s)
Adhesión a Directriz , Infertilidad/terapia , Inseminación Artificial Homóloga/normas , Adulto , Estudios de Cohortes , Femenino , Humanos , Persona de Mediana Edad , Países Bajos , Embarazo , Estudios RetrospectivosRESUMEN
OBJECTIVE: To identify subfertile couples' experiences with specific aspects of intrauterine insemination (IUI) care and to determine which patient and hospital characteristics affect their experiences. DESIGN: Cross-sectional survey with written questionnaires. SETTING: One large tertiary hospital and nine medium-sized hospitals, including both teaching and nonteaching centers, in the southeast of the Netherlands. PATIENT(S): One thousand seventy-nine subfertile couples who underwent IUI treatment between April 2000 and August 2002. RESULT(S): The response rate was 71%. Many subfertile couples have had negative experiences with IUI care, particularly regarding the doctor's attitude and coordination of care. Among several patient and hospital characteristics that significantly predicted these negative experiences, the main predictors were no ongoing pregnancy and high education level. CONCLUSION(S): From the perspective of subfertile couples, several aspects of IUI care are in serious need of improvement, particularly care aspects regarding the doctor's attitude and coordination of care. These findings are an important incentive for developing tailored interventions that address the reported deficits in IUI care to meet subfertile couples' needs better.