title: Reliability of league tables of in vitro fertilisation clinics: retrospective analysis of live birth rates.
abstract: OBJECTIVE
  To determine to what extent institutions carrying out in vitro fertilisation can reasonably be ranked according to their live birth rates.
  
  
  METHODS
  Retrospective analysis of prospectively collected data on live birth rate after in vitro fertilisation.
  
  
  METHODS
  52 clinics in the United Kingdom carrying out in vitro fertilisation over the period April 1994 to March 1995.
  
  
  METHODS
  Estimated adjusted live birth rate for each clinic; their rank and its associated uncertainty.
  
  
  RESULTS
  There were substantial and significant differences between the live birth rates of the clinics. There was great uncertainty, however, concerning the true ranks, particularly for the smaller clinics. Only one clinic could be confidently ranked in the bottom quarter according to this measure of performance. Many centres had substantial changes in rank between years, even though their live birth rate did not change significantly.
  
  
  CONCLUSIONS
  Even when there are substantial differences between institutions, ranks are extremely unreliable statistical summaries of performance and change in performance, particularly for smaller institutions. Any performance indicator should always be associated with a measure of sampling variability.
authors.affiliation: MRC Biostatistics Unit, Institute of Public Health, Cambridge CB2 2SR.
authors.forename: E C
authors.initials: EC
authors.lastname: Marshall
authors.forename: D J
authors.initials: DJ
authors.lastname: Spiegelhalter
mesh_terms: D001723:Birth Rate; D005307:Fertilization in Vitro / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D006113:United Kingdom