Patient and hospital characteristics associated with variation in guideline adherence in intrauterine insemination care

Objective. To assess the association of patient and hospital characteristics with adherence to guidelines for intrauterine insemination (IUI) care. Design. 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. Setting and Participants. Five hundred and fifty-eight subfertile couples who underwent IUI treatment at 10 Dutch hospitals. Main Outcome Measures. Adherence to systematically developed guideline-based performance indicators describing 20 processes of IUI care. Results. A total of 558 couples who started 2334 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.