title: Defining poor and optimum performance in an IVF programme.
abstract: BACKGROUND
  At present there is considerable interest in healthcare administration, among professionals and among the general public concerning the quality of programmes of assisted reproduction. There exist various methods for comparing and analysing the results of clinical activity, with graphical methods being the most commonly used for this purpose. As yet, there is no general consensus as to how the poor performance (PP) or optimum performance (OP) of assisted reproductive technologies should be defined.
  
  
  METHODS
  Data from the IVF/ICSI register of the Spanish Fertility Society were used to compare and analyse different definitions of PP or OP. The primary variable best reflecting the quality of an IVF/ICSI programme was taken to be the percentage of singleton births per IVF/ICSI cycle initiated. Of the 75 infertility clinics that took part in the SEF-2003 survey, data on births were provided by 58. A total of 25 462 cycles were analysed. The following graphical classification methods were used: ranking of the proportion of singleton births per cycles started in each centre (league table), Shewhart control charts, funnel plots, best and worst-case scenarios and state of the art methods.
  
  
  RESULTS
  The clinics classified as producing PP or OP varied considerably depending on the classification method used. Only three were rated as providing 'PP' or 'OP' by all methods, unanimously. Another four clinics were classified as 'poor' or 'optimum' by all the methods except one.
  
  
  CONCLUSIONS
  On interpreting the results derived from IVF/ICSI centres, it is essential to take into account the characteristics of the method used for this purpose.
authors.affiliation: Unidad de Reproducción, HU Virgen de las Nieves, E-18014 Granada, Spain. josea.castilla.sspa@juntadeandalucia.es
authors.forename: Jose A
authors.initials: JA
authors.lastname: Castilla
authors.forename: Juana
authors.initials: J
authors.lastname: Hernandez
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Cabello
authors.forename: Alejandro
authors.initials: A
authors.lastname: Lafuente
authors.forename: Nuria
authors.initials: N
authors.lastname: Pajuelo
authors.forename: Javier
authors.initials: J
authors.lastname: Marqueta
authors.forename: Buenaventura
authors.initials: B
authors.lastname: Coroleu
mesh_terms: D001723:Birth Rate; D005260:Female; D005307:Fertilization in Vitro / Q000592:standards*; D006801:Humans; D011785:Quality Assurance, Health Care / Q000379:methods; D011787:Quality of Health Care; D012042:Registries; D020554:Sperm Injections, Intracytoplasmic