title: Patient and hospital characteristics associated with variation in guideline adherence in intrauterine insemination care.
abstract: OBJECTIVE
  To assess the association of patient and hospital characteristics with adherence to guidelines for intrauterine insemination (IUI) care.
  
  
  METHODS
  Retrospective cohort study using multilevel regression analysis. Characteristics studied at the patient level were female age, type and duration of subfertility, diagnosis and number of started IUI cycles. At the hospital level, the characteristics studied were hospital size, teaching hospital, in vitro fertilization (IVF) licence and number of physicians involved in the IUI programme. Data were obtained from medical records and questionnaires for gynaecologists.
  
  
  METHODS
  Five hundred and fifty-eight subfertile couples who underwent IUI treatment at 10 Dutch hospitals.
  
  
  METHODS
  Adherence to systematically developed guideline-based performance indicators describing 20 processes of IUI care.
  
  
  RESULTS
  A total of 558 couples who started 2,334 IUI cycles participated. Guideline adherence in IUI care was often substandard and varied considerably between hospitals. Variation in guideline adherence in IUI care was associated with the patient characteristics 'diagnosis' and 'female age'. Only adherence to the guideline recommendation regarding 'screening for tubal occlusion' was associated with hospital characteristics ('hospital size' and 'IVF licence'). Large explained variances up to 39% were found for the different models.
  
  
  CONCLUSIONS
  A number of patient and hospital characteristics were associated with variation in guideline adherence in IUI care, particularly the patient characteristics 'diagnosis' and 'female age'. The identification of different subgroups in the patient population and different types of hospitals with regard to the extent of guideline adherence in IUI care is important for the tailoring of interventions to improve IUI care.
authors.affiliation: 1Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Rosella P M G
authors.initials: RP
authors.lastname: Hermens
authors.forename: Esther C
authors.initials: EC
authors.lastname: Haagen
authors.forename: Willianne L D M
authors.initials: WL
authors.lastname: Nelen
authors.forename: Evelien M
authors.initials: EM
authors.lastname: Tepe
authors.forename: Reinier
authors.initials: R
authors.lastname: Akkermans
authors.forename: Jan A M
authors.initials: JA
authors.lastname: Kremer
authors.forename: Richard P T M
authors.initials: RP
authors.lastname: Grol
mesh_terms: D000328:Adult; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D007247:Infertility, Female / Q000145:classification / Q000209:etiology / Q000628:therapy*; D007248:Infertility, Male / Q000145:classification / Q000209:etiology / Q000628:therapy*; D007315:Insemination, Artificial / Q000592:standards*; D008297:Male; D008423:Maternal Age; D008499:Medical Records; D008875:Middle Aged; D009426:Netherlands; D058996:Quality Improvement; D012189:Retrospective Studies; D055815:Young Adult