Dan Gong1, Emre Seli. 1. Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA.
Abstract
OBJECTIVE: To quantitatively determine the relationship between fertility clinic performance and cycle volume, and to assess the implications for public reporting of provider performance data. DESIGN: Retrospective longitudinal analysis. SETTING: Clinic. PATIENT(S): The study population included 307 U.S. assisted reproductive technology (ART) clinics that continuously reported performance data to the Centers for Disease Control from 2003 to 2008. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Regression coefficients between pregnancy rate per cycle, live birth rate per cycle, or live birth rate per transfer and number of ART cycles performed. RESULT(S): Overall, there was no association found between a clinic's most recently reported success rate and its cycle volume. This finding was consistent across three time periods studied. Moreover, stratification analyses of clinics with greater than ±5%, ±10%, and ±20% change in success rates also found no association between clinic performance and cycle volume. CONCLUSION(S): As proxied by cycle volume data, patients seeking ART treatment do not seem to be influenced by positive or negative changes in a clinic's performance despite the public availability of this data. These results suggest that current public quality reporting encompassing success rates alone will not change patient behavior and therefore is insufficient to place salient competitive pressure on health care providers. Further research is necessary to define provider performance comprehensively and to determine the metrics, if any, to which patients respond.
OBJECTIVE: To quantitatively determine the relationship between fertility clinic performance and cycle volume, and to assess the implications for public reporting of provider performance data. DESIGN: Retrospective longitudinal analysis. SETTING: Clinic. PATIENT(S): The study population included 307 U.S. assisted reproductive technology (ART) clinics that continuously reported performance data to the Centers for Disease Control from 2003 to 2008. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Regression coefficients between pregnancy rate per cycle, live birth rate per cycle, or live birth rate per transfer and number of ART cycles performed. RESULT(S): Overall, there was no association found between a clinic's most recently reported success rate and its cycle volume. This finding was consistent across three time periods studied. Moreover, stratification analyses of clinics with greater than ±5%, ±10%, and ±20% change in success rates also found no association between clinic performance and cycle volume. CONCLUSION(S): As proxied by cycle volume data, patients seeking ART treatment do not seem to be influenced by positive or negative changes in a clinic's performance despite the public availability of this data. These results suggest that current public quality reporting encompassing success rates alone will not change patient behavior and therefore is insufficient to place salient competitive pressure on health care providers. Further research is necessary to define provider performance comprehensively and to determine the metrics, if any, to which patients respond.