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Benchmarking patientcentredness in The Netherlands (fertility care)
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Benchmarking patientcentredness in The Netherlands (fertility care)


Presentation ESHRE Leuven 7-2-13. …

Presentation ESHRE Leuven 7-2-13.
How to measure patientcentredness, how to benchark patientcentredness and how to improve patientcentredness.

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  • 1. Trustworthy national benchmarking forpatient-centeredness in infertility care Prof dr Jan A.M. Kremer, gynaecologist Radboud University Nijmegen Medical Centre Twitter: @JKNL #ESHREinnovations Email: Leuven, February 7th, 2013
  • 2. Course objectives• Know the definition, dimensions and importance of patient-centred care• Know the tools that can be used for measuring and improving patientcentredness• Get inspired to work in measuring and improving patientcentredness in your own clinic
  • 3. Don Berwick
  • 4. Heyendael Castle, 2001
  • 5. Paradigm shift • Not the system should be dominant, but the patient as a person should be dominant • Don Berwick: ‘we should behave with patients not as hosts in the care system but as guests in their lives’ • Patientcentredness
  • 6. What is patientcentredness?• Patient-centred ART ≠ Patient-friendly ART • False attractiveness: too positive, ART and infertility is not friendly at all • No clear definition: could be used for any less invasive form of ART • Commercial incentives: can be used to prevent drop-outs and to increase the turnover of cycles and medication• More than just being nice to patients• Patient centeredness ≠ patient satisfaction
  • 7. What is patientcentredness?• Focus on patient’s experiences and needs• Institute of Medicine, 2001: Being respectful of (and responsive to) individual patient preferences, needs and values; and ensuring that patient values guide all clinical decisions.
  • 8. Dimension of quality of care 1. Safety 2. Effectiveness 3. Timeliness 4. Efficiency 5. Equity of access 6. Patient centerednessBengoa (WHO), 2006 and Corrigan (IOM), 2001
  • 9. Dimensions of patient centeredness1. Access to care2. Respect for patients values, preferences, needs3. Coordination and integration of care4. Information, communication and education5. Physical comfort6. Emotional support and alleviation of fear and anxiety7. Involvement of family and friends8. Transition and continuity
  • 10. How to measure patientcentredness? • If you can not measure it, you can not improve it • Not easy, because of the fuzzy concept • Focus groups, interviews, qualitative studies (e.g. storytellers) and questionnaires • Measure experiences and not satisfaction • Focus on the eight dimensions of PCM
  • 11. A. Group interviews
  • 12. B. PCQ Infertility• A national measurement instrument• Validation study van Empel et al., Hum Reprod. 2010• Available in Dutch and English• Online available: • •
  • 13. Examples of questions (n=46)
  • 14. Examples of feedback
  • 15. PCQ scores (NL) * Range 0 – 3
  • 16. Quality Improvement scores QI = Importance x (3 – Experience) * Range 0 – 9
  • 17. C. Improvement of patientcentredness• Quiss study (Dana Huppelschoten)• Multifaceted approach: 1. Feedback report (QI-scores) 2. Educational outreach visits (team, patient, quality expert, researcher) 3. Patient-mediated interventions (focus groups, online communities, …)
  • 18. Cluster-randomized trial (n=32; n=1620)
  • 19. Results of PCQ 0 (n=32)
  • 20. Educational outreach visits (n=16) • 82 actions: 3-7 per hospital, based on their scores 36 actions completed (May 2011)
  • 21. Examples of improvement actions • Patients receive a card with the name of key doctor • Each patient will get a standard evaluation visit after three IUI cycles • Patients receive a scheme of the time schedule of the treatment • Emotional aspects will be discussed during each evaluation consultation
  • 22. Results will follow in 2013 • ……………. • ……………. • ……………. • …………….
  • 23. National benchmarking Dutch Society of Reproductive Medicine (Annemijn Aarts) • Adopted the PCQ as indicator for patient-centredness • Acknowledges patient-centredness as equal to other quality measures, such as effectiveness (pregnancy rates) and safety (twin births) • Annual measurement of Dutch fertility clinics to monitor and improve patientcentredness
  • 24. Clinic invites their patients to the questionnaire
  • 25. Benchmark and feedback Website generates feedback reports • Anonymously benchmark of PCQ dimensions • Insight on individual care scores of your own clinic • DSRM has insight in national scores, not in individual scores
  • 26. We want children, …how static & top-down.but most of all we As modern care want patient- consumers, we want more centred care… than just being treated!