title: Quality indicators for all dimensions of infertility care quality: consensus between professionals and patients.
abstract: OBJECTIVE
  What is the relative importance of the six dimensions of quality of care according to different stakeholders and can a quality indicator set address all six quality dimensions and incorporate the views from professionals working in different disciplines and from patients?
  
  
  CONCLUSIONS
  Safety, effectiveness and patient centeredness were the most important quality dimensions. All six quality dimensions can be assessed with a set of 24 quality indicators, which is face valid and acceptable according to both professionals from different disciplines and patients.
  
  
  BACKGROUND
  To our knowledge, no study has weighted the relative importance of all quality dimensions to infertility care. Additionally, there are very few infertility care-specific quality indicators and no quality indicator set covers all six quality dimensions and incorporated the views of professionals and patients.
  
  
  METHODS
  A three-round iterative Delphi survey including patients and professionals from four different fields, conducted in two European countries over the course of 2011 and 2012.
  Dutch and Belgian gynaecologists, embryologists, counsellors, nurses/midwifes and patients took part (n = 43 in round 1 and finally 30 in round 3). Respondents ranked the six quality dimensions twice for importance and their agreement was evaluated. Furthermore, in round 1, respondents gave suggestions, which were subsequently uniformly formulated as quality indicators. In rounds 2 and 3, respondents rated the quality indicators for preparedness to measure and for importance (relation to quality and prioritization for benchmarking). Providing feedback allowed selecting indicators based on consensus between stakeholder groups. Measurable indicators, important to all stakeholder groups, were selected for each quality dimension.
  
  
  RESULTS
  All stakeholder groups and most individuals agreed that safety, effectiveness and patient centeredness were the most important quality dimensions. A total of 498 suggestions led to the development of 298 indicators. Professionals were sufficiently prepared to measure 204 of these indicators. Based on importance, 52 (7-15 per dimension; round 2) and finally 24 (4 per dimension; round 3) quality indicators were selected.
  
  
  CONCLUSIONS
  The final quality indicator set does not cover the entire care process, but rather takes a 'sample' of each quality dimension. Although the quality indicators are face valid and acceptable, their psychometric characteristics need to be tested by further research.
  
  
  CONCLUSIONS
  Quality management should focus on safety, effectiveness and patient centeredness of care. Clinics can use the quality indicator set to assess all quality dimensions of their care.
authors.affiliation: Leuven University Hospital, Leuven University Fertility Centre, Herestraat 49, Leuven 3000, Belgium.
authors.forename: E A F
authors.initials: EA
authors.lastname: Dancet
authors.forename: T M
authors.initials: TM
authors.lastname: D'Hooghe
authors.forename: C
authors.initials: C
authors.lastname: Spiessens
authors.forename: W
authors.initials: W
authors.lastname: Sermeus
authors.forename: D
authors.initials: D
authors.lastname: De Neubourg
authors.forename: N
authors.initials: N
authors.lastname: Karel
authors.forename: J A M
authors.initials: JA
authors.lastname: Kremer
authors.forename: W L D M
authors.initials: WL
authors.lastname: Nelen
mesh_terms: D001530:Belgium; D032921:Consensus; D003697:Delphi Technique; D005260:Female; D006282:Health Personnel; D006801:Humans; D007246:Infertility; D009426:Netherlands; D005791:Patient Care / Q000592:standards*; D010361:Patients; D019984:Quality Indicators, Health Care
keywords: assisted reproduction; infertility; quality control