Improving fertility care. The role of guidelines, quality indicators and patients.
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RU Radboud Universiteit Nijmegen, 21 april 2010
Promotores : Grol, R.P.T.M., Kremer, J.A.M. Co-promotores : Hermens, R.P.M.G., Nelen, W.L.D.M.
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Centre for Quality of Care Research
SubjectNCEBP 4: Quality of hospital and integrated care
Clinical practice guidelines can help improve the quality of care, and decrease variation in delivered care between settings. However, as guidelines do not implement themselves, efforts should be made to improve current guideline implementation. For clinical fertility care, we performed a large multi-centre study in 16 fertility clinics in the Netherlands which assessed current fertility care; the recommendations within the Dutch guideline programme for fertility care, issued by the 10 Dutch Society of Obstetrics and Gynaecology was taken as a basis. For this purpose, from the 10 Dutch fertility guidelines, a set of 39 guideline-based quality indicators was systematically developed by means of a RAND-modified Delphi method. These quality indicators do not only relate to outcomes of care, but explicitly focus on process and structure of care. The current care assessment revealed a large variation in fertility care between settings. Especially the practice of information provision to patients appeared to be substandard. Patients however, were highly satisfied with delivered care. The indicator set was moreover tested for several quality criteria and appeared to be a valid instrument for fertility care assessment. We aimed to improve the fertility guideline implementation by means of two implementation strategies, one aiming at the professional only, and a second one aiming for both the professional and. Unfortunately, none of the proposed strategies had an overall positive effect on guideline implementation. Process evaluation of the interventions applied, revealed that one explanation for the absence of a positive effect of the implementation strategies could be incomplete execution of the intervention by professionals. However, evaluation among patients did reveal promising results for future patient-directed implementation of guidelines, as improved doctor-patient communication, experienced increased empowerment and a higher degree of understanding of professional guidelines and professionals’ treatment decisions were reported.
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