| Objective:Through the understanding of the status quo of quality control and quality management of assisted reproductive medicine specialized hospitals in Yunnan Province,the quality control theory is used to guide and create quality control indicators assessment system,and then to analyze the influencing factors in the total quality management of assisted reproductive departments in hospital.Through the quality improvement measures to verify the effectiveness and quality improvement effect of the quality control indicators assessment system,then to improve the quality control level of the assisted reproductive laboratory and to gain quality control experience and implement continuous quality improvement.Methods:This study used self-control studies to select the most representative key performance indicators for each stage of assisted reproductive technology,such as IVF normal fertilization rate and ICSI normal fertilization rate which on behalf of laboratory procedures.The number of oocytes retrieved which represents clinical treatment process.The number of available embryos and the rate of blastocyst development rate which represent cultivation stage in the laboratory.The implantation rate and the clinical pregnancy rate which represent clinical stage.The KPIs data of public hospital and private hospital were collected after being permited,the data of the 20-months treatment cycle from Jan 2017 to Aug 2018 of the two hospitals were individually extracted and analyzed after age stratification,and the quality control assessment system was used to analyze the causes of poor quality.Then,quality control quality improvement was conducted for private hospital after the improving strategy had been proposed,and the data of the 6 months treatment cycle after quality improvement was collected for comparative analysis before and after to verify whether the analyzed causes and quality improvement effects were correct and effective,and finally to obtain the experience of quality control evaluation and quality improvement.The collected database were established by using of Epidata 3.1 software,the x±s were used to describe the measurement data,and the differences between the two groups were compared by using of independent sample t test or rank sum test.The percentage was used to describe the enumeration data,and the ?2 test was used to compare the difference between the two parts.The test level was a=0.05.Results:(I)There were statistically significant differences between two stratified age groups both in two hospitals(P<0.05)for female age,BMI,infertility years,infertility reasons,LH levels at Hcg day,E2 levels at Hcg day,P levels at Hcg day.(2)There were statistically significant differences between two stratified age groups both in before and after quality improvement of hospital B(P<0.05)for female age,BMI,infertility years,infertility reasons,LH levels at Hcg day,E2 levels at Hcg day,P levels at Hcg day.(3)There have statistically significant differences(P<0.05)between two hospitals for indicators not only like IVF normal fertilization rate,ICSI normal fertilization rate,blastocyst development rate,and available embryos,but the number of oocytes retrieved in<35 years old group,and the blastocyst development rate in>35 years old group.(4)In public hospital,IVF normal fertilization rate is 61.61%,ICSI normal fertilization rate is 77.47%,the blastocyst development rate is 19.36%,the implantation rate is 16.67%,the clinical pregnancy rate is 35.76%,The x±s of the number of oocytes retrieved and of the number of available embryos is 10.04±7.17 and 4.73±3.41 respectively.IVF normal fertilization rate is 65.36%and 55.43%for<35 years old group and>35 years old group,P<0.05;ICSI normal fertilization rate is 78.22%and 76.33%for<35 years old group and>35 years old group,P>0.05;The blastocyst development rate is 27.36%and 9.25%for<35 years old group and>35 years old group,P<0.05;The implantation rate is 15.32%and 19.39%for<35 years old group and?35 years old group,P>0.05;The clinical pregnancy rate is 38.33%and 3333%for<35 years old group and>35 years old group,P<0.05;The x±s of the number of oocytes retrieved is 12.29±7.19 and 6.23±5.10 for<35 years old group and>35 years old group,P<0.05;The x±s of the number of available embryos is 5.60±3.50 and 3.35±2.75 for<35 years old group and>35 years old group,P<0.05.(5)In private hospital,IVF normal fertilization rate is 63.51%,ICSI normal fertilization rate is 60.23%,the blastocyst development rate is 22.04%,the implantation rate is 14.73%,the clinical pregnancy rate is 33.31%,The x±s of the number of oocytes retrieved and of the number of available embryos is 9.96±7.07 and 7.24±5.56 respectively.IVF normal fertilization rate is 63.23%and 64.30%for<35 years old group and>35 years old group,P>0.05;ICSI normal fertilization rate is 60.22%and 60.27%for<35 years old group and>35 years old group,P>0.05;The blastocyst development rate is 25.22%and 13.21%for<35 years old group and>35 years old group,P<0.05;The implantation rate is 14.53%and 15.23%for<35 years old group and>35 years old group,P>0.05;The clinical pregnancy rate is 34.30%and 28.23%for<35 years old group and?35 years old group,P<0.05;The x±s of the number of oocytes retrieved is 11.49±7.07 and 5.69±5.02 for<35 years old group and>35 years old group,P<0.05;The-x±s of the number of available embryos is 8.32±5.63 and 4.22±4.06 for<35 years old group and>35 years old group,P<0.05.(6)After the quality improvement of private hospital,IVF normal fertilization rate is 65.87%,ICSI normal fertilization rate is 66.04%,the blastocyst development rate is 36.11%,the implantation rate is 17.04%,the clinical pregnancy rate is 37.89%,The xQs of the number of oocytes retrieved and of the number of available embryos is 15.18±7.94 and 12.35±6.74 respectively.IVF normal fertilization rate is 65.19%and 67.20%for<35 years old group and?35 years old group,P>0.05;ICSI normal fertilization rate is 65.17%and 66.20%for<35 years old group and>35 years old group,P>0.05;The blastocyst development rate is 37.66%and 33.15%for<35 years old group and>35 years old group,P>0.05;The implantation rate is 17.33%and 15.83%for<35 years old group and?35 years old group,P>0.05;The clinical pregnancy rate is 39.39%and 33.32%for<35 years old group and?35 years old group,P<0.05;The x±s of the number of oocytes retrieved is 16.16±7.89 and 9.99±5.98 for<35 years old group and?35 years old group,P<0.05;The x±s of the number of available embryos is 13.04±6.77 and 8.68±5.68 for<35 years old group and>35 years old group,P<0.05.(7)There have statistically significant differences before and after in private hospital(P<0.05),the indicators envolved not only like IVF normal fertilization rate,ICSI normal fertilization rate,the blastocyst development rate,the number of oocytes retrieved and the number of available embryos and the clinical pregnancy rate,but IVF normal fertilization rate and ICSI normal fertilization rate in<35 years old groups.Conclusion:The KPIs of both public hospital and private hospital are lower than average,and reserving a large room for improvement.However,it is necessary to face up to the problem and to make determination to intervene.This study presents the five-steps method of reviewing data,establishing evaluation system,path analysis,implement quality improvement,effect verification and gain the experience.Through continuous repeating this circulation can effectively and smoothly improve the quality output,while,it can be used as a routine work for quality management of assisted reproductive centers. |
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