Guideline adherence in ectopic pregnancy management.
BACKGROUND
Evidence-based guidelines have been issued for ectopic pregnancy (EP), covering both diagnostic and therapeutic management. In general, guidelines aim to reduce practice variation and to improve quality of care. To assess the guideline adherence in the management of EP, we developed guideline-based quality indicators and measured patient care in various hospitals.


METHODS
A panel of experts and clinicians developed quality indicators based on recommendations from the Dutch guideline on EP management, using the systematic RAND-modified Delphi method. With these indicators, patient care was assessed in six Dutch hospitals between January 2003 and December 2005. For each quality indicator, a ratio for guideline adherence was calculated. Overall adherence was reported, as well as adherence per hospital type, i.e. academic, teaching and non-teaching hospitals.


RESULTS
Out of 30 guideline-based recommendations, 12 quality indicators were selected covering procedural, structural and outcome aspects of care. For 317 women surgically treated for EP, these aspects were assessed. Overall adherence to the guideline was 75%. The highest adherence (98%) was observed for performing transvaginal sonography during the diagnostic workup. The lowest adherence (21%) was observed for performing salpingotomy in case of contra-lateral tubal pathology. Wide variance in adherence (0-100%) existed between academic, teaching and non-teaching hospitals.


CONCLUSIONS
The overall guideline adherence was reasonable, with ample room for improvement in various aspects of care. Further research should focus on the barriers for guideline dissemination and adherence, to further improve the management of EP.
Centre for Reproductive Medicine, Academic Medical Centre, PO Box 22660, 1100 DD Amsterdam, The Netherlands. f.mol@amc.nl
F
F
Mol
E
E
van den Boogaard
N M
NM
van Mello
F
F
van der Veen
B W
BW
Mol
W M
WM
Ankum
P
P
van Zonneveld
A B
AB
Dijkman
H R
HR
Verhoeve
A
A
Mozes
M
M
Goddijn
P J
PJ
Hajenius
D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007518:Isoantibodies / Q000627:therapeutic use; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012203:Rh Isoimmunization / Q000188:drug therapy; D018029:Rho(D) Immune Globulin; D058994:Salpingectomy
D006063:Chorionic Gonadotropin; D007518:Isoantibodies; C061961:RHO(D) antibody; D018029:Rho(D) Immune Globulin