Editorial: Two cheers for clinical practice guidelines: the hopes and headaches of quality improvement in reproductive healthcare

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Ed Hughes*

Professor of Obstetrics and Gynecology, McMaster University, 1200 Main Street West, Hamilton, ON, Canada L8N 3Z5*Correspondence address. E-mail: hughese{at}mcmaster.caReceived January 12, 2011. Revision received January 12, 2011. Accepted January 14, 2011. Effective and timely knowledge transfer is the engine of evidence-based medicine. ESHRE and other professional societies are key players in the process of knowledge transfer. They facilitate scientific dialogue in many different ways and provide frameworks for the generation of clinical practice guidelines (CPGs). While enormous thought and effort goes into the execution of clinical trials and the subsequent development of CPGs based on them, little is known about the effectiveness of guideline uptake in the field of reproductive medicine. How successful are guidelines in improving quality of care? What strategies beyond simple guideline publication, most effectively lead to change in practice? The study by Mourad et al. ( 2010) takes a bold and pragmatic look at these questions, on behalf of fertility care-givers and patients.

Based in Holland, this group used a relatively new and increasingly common design platform: cluster randomization. This means that the unit of allocation was not, as is usual, the individual patient, but instead a group of patients, in this case those attending a particular fertility clinic. The main reason for using cluster randomization is to avoid the risk of contamination: to keep separate the influences of the two strategies under study. Here, it would have been impossible to provide two types of CPG reinforcement strategy to the same physicians and expect them to apply them separately to individual patients within their practices. Important limitations of cluster randomization stem from the correlation that exists between patients within …

This ArticleHum. Reprod. (2011) 26 (4): 815-816. doi: 10.1093/humrep/der023 First published online: February 2, 2011

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