Guideline-based development of quality indicators for subfertility care

BACKGROUND: Internationally, several organizations have developed clinicalguidelines for subfertility care to supply patients with thebest possible care. However, to improve the implementation ofsuch guidelines, we first need to gain insight into the applicationof clinical guidelines in daily practice. Valid quality indicatorsare necessary to estimate actual guideline adherence. However,none of the existing subfertility guideline programmes is accompaniedby a satisfactory set of quality indicators. In this study,we develop a set of valid guideline-based quality indicatorsfor subfertility care. METHODS: A systematic RAND-modified Delphi method was used to developa set of key recommendations based on 10 national Dutch subfertilityguidelines, international literature and existing internationalindicators. Experts’ opinions were used to appraise recommendationsregarding specific criteria such as efficacy, level of healthgain, applicability and potential for care improvement. RESULTS: A representative set of 39 key recommendations was selectedfrom 303 initial recommendations. The recommendations coveredtwo structural and 37 procedural aspects, the latter encompassing‘indications for treatment’, ‘diagnostic procedures’,‘treatment procedures’ and ‘patient information’. CONCLUSIONS: This study describes the systematic, stepwise method used todevelop 39 process and structure indicators that can be usedto monitor subfertility care.