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Feedback to professionals on patient-centered fertility care is insufficient for improvement: a mixed-method study
Aleida G Huppelschoten1, Johanna W M Aarts, Inge W H van Empel
1Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
Objective:
To determine the effect of audits and feedback on the level of patient-centeredness in fertility care, and to obtain a more in-depth understanding of professionals' views on patient-centered care and achieving improvements.
Design:
Mixed-method design, using semistructured in-depth interviews and patient questionnaires.
Setting:
Fifteen Dutch fertility clinics.
Patient(S):
Women in infertility treatment (quantitative section) and fertility care professionals (qualitative section).
Intervention(S):
Audit of the level of patient-centeredness of care, and feedback provided to clinics by a personalized paper-based feedback report.
Main Outcome Measure(S):
Quantitative section: the patient-reported differences in the level of patient-centered fertility care between 2009 and 2011 measured by the Patient-Centeredness Questionnaire-Infertility. Qualitative section: professionals views on improving patient-centered fertility care arranged into a Hibbard framework for behavioral change.
Result(S):
Multilevel regression analysis showed no statistically significant differences between the overall levels of patient-centeredness in 2009 and 2011. Qualitative research showed that professionals' urge to change and their ability to translate feedback were suboptimal to achieve behavioral change.
Conclusion(S):
Audits and feedback alone are not enough to improve the level of patient-centeredness in fertility care. Increasing professionals' desire to change and their ability to translate feedback about their performance into an optimal quality improvement strategy appear to be the key issues.
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