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

In audit and feedback methods to improve patientcenteredness in fertility care, the key issues are increasing professionals’ knowledge about their performance and their desire to make changes.


Aleida G. Huppelschoten, M.D., Johanna W.M. Aarts, M.D., Ph.D., Inge W. H. van Empel, M.D., Ph.D., Ben J. Cohlen, M.D., Ph.D., Jan A. M. Kremer, M.D., Ph.D., Willianne L.D.M. Nelen, M.D., Ph.D.

Volume 99, Issue 5, Pages 1419-1427, April 2013



To determine the effect of audit and feedback on the level of patient-centeredness in fertility care, and getting more in-depth understanding of professionals’ view on patient-centered care and how improvement could be achieved.


Mixed-method design, using semi-structured in depth interviews and patients’ questionnaires.


Fifteen Dutch fertility clinics.


Women under treatment for infertility (quantitative part) and fertility care professionals (qualitative part).


After auditing the level of patient-centeredness of care in 2009, feedback was provided to the clinics by a personalized paper-based feedback report.

Main Outcome Measure(s):

Quantitative part: Patients’ reported differences in the level of patient-centered fertility care between 2009 and 2011 measured by the PCQ-Infertility questionnaire. Qualitative part: Professionals’ view on improving patient-centered fertility care arranged into Hibbard’s framework for behavior change.


Multilevel regression analysis showed no 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 professionals’ behavior change.


Audit and feedback solely is not enough to improve the level of patient-centeredness in fertility care. Increasing professionals’ urge to change and their ability to translate feedback about their performance into an optimal quality improvement strategy seems the key issues.

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