Guideline-based development of quality indicators for subfertility care.

BACKGROUND Internationally, several organizations have developed clinical guidelines for subfertility care to supply patients with the best possible care. However, to improve the implementation of such guidelines, we first need to gain insight into the application of clinical guidelines in daily practice. Valid quality indicators are necessary to estimate actual guideline adherence. However, none of the existing subfertility guideline programmes is accompanied by a satisfactory set of quality indicators. In this study, we develop a set of valid guideline-based quality indicators for subfertility care. METHODS A systematic RAND-modified Delphi method was used to develop a set of key recommendations based on 10 national Dutch subfertility guidelines, international literature and existing international indicators. Experts' opinions were used to appraise recommendations regarding specific criteria such as efficacy, level of health gain, applicability and potential for care improvement. RESULTS A representative set of 39 key recommendations was selected from 303 initial recommendations. The recommendations covered two 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 to develop 39 process and structure indicators that can be used to monitor subfertility care.