Feedback to professionals on patient-centered fertility care is insufficient for improvement: a mixed-method study

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. (Fertil Steril (R) 2013;99:1419-27. (C) 2013 by American Society for Reproductive Medicine.)