Incorporating natural variation into IVF clinic league tables

Abstract

There is great uncertainty about the ratings. To show the magnitude of uncertainty, league tables should include the best-case scenario and the worst-case scenario ratings of each clinic.

Incorporating natural variation into IVF clinic league tables: The Expected Rank

“…Lemmers et al proposed a best and worst case ranking and Spiegelhalter et al proposed a 95% confidence interval around the ranks. [5,6] Both methods provide 3 numbers: a 'point estimate' and the uncertainty around this estimate. The ER consists of only one number, which is an advantage in our perspective because it is generally easier to process one number than three numbers.…”

“…Lemmers et al recently proposed a best-case and worst-case scenario ranking and illustrated this approach on the dataset we also use in this paper. [5] Marshall et al calculated 95% confidence intervals to the ranks. [6] The aim of this study is to present another method: the Expected Rank (ER), which prevents over interpretation of the rankings.…”

Only 10% of the psychotropic drug use for neuropsychiatric symptoms in patients with dementia is fully appropriate. The PROPER I-study

“…Third, the different outcomes were ranked using ranking (League) tables (Lemmers et al, 2007), i.e. outcomes are ranked according to the 95% CI of the mean APID sum score.…”

Uncertainty in clinical data and stochastic model for in vitro fertilization

“…The anxiety and stress of the overall procedure can have a huge impact on the patient's responsiveness to the medications. The report on incorporating natural variations into IVF clinic tables by Lemmers et al (2007) suggest that the result of any IVF cycle will lie within the best-case and worst-case scenario observed at that particular clinic.…”

“…Since the existing protocols (Meniru and Craft, 1997;Loutradis et al, 2007) for superovulation are largely dependent upon the clinical observations for deciding the hormonal dosage on the next day of the cycle, it is essential to look into the possible errors in the follicle growth measurements and reporting. The uncertainty in the IVF outcomes specific to the particular clinic has been addressed by Lemmers et al (2007), but we intend to characterize the uncertainty specific to the patient and the ongoing cycle, which makes the procedure more acceptable. In the current work, we are proposing a method to characterize the uncertainty in the ongoing cycle.…”