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.