Nordic Perinatal Statistics Collected by NOMBIR (Nordic Medical Birth Registers) Mika Gissler.
Quality Registers in Finland The Importance to Measure ... · Total fertility rate by the age at...
Transcript of Quality Registers in Finland The Importance to Measure ... · Total fertility rate by the age at...
28.1.2019 1
Quality Registers in Finland – The Importance to Measure Fertility Treatments
Mika Gissler, THL
National, mandatory data collections on reproductive health maintained by THL
▪ Register on Congenital Malformations since 1963
▪ Register on induced abortions and sterilisations since 1983 (statistics since 1950/1939)
▪ Medical Birth Register since 1987
– More detailed data on very premature children since 2005 (< 1501 grams or < 32 gestational weeks)
▪ Statistics on IVF/IUI since 1992/2005
▪ Drug and pregnancy –research database on use of medication during pregnancy and its consequences since 1996
28/01/2019 2
National, mandatory registers on reproductive health maintained by THL
▪ Information on hospital care related to reproduction is available in the Hospital Discharge Register
– Hospital inpatient care since 1967
– Hospital day surgery since 1994
– Social institutions since 1995
– Hospital outpatient visits since 1998
– Primary health care visits since 2011
28/01/2019 3
Total fertility rate decreases in Finland
28.1.2019 4
Total fertility rate in the Nordic countries
28.1.2019 5
Fertility rate per 1000 women by age
28.1.2019 6
The mean age of parturients, years
28.1.2019 7
The number of ART treatments
28.1.2019 8
The number of ART treatmentsper 1000 women aged 15-49 years
28.1.2019 9
Total fertility rate by the age at first birth
Roustaei Z, Räisänen S, Gissler M, Heinonen S: Fertility rates and the postponement of first births: a descriptive study with Finnish population data. BMJ Open 2018.
28.1.2019 10
The number of ART treatmentsper 1000 women aged 15-49 years, 2015
28.1.2019 11
The proportion of IVF+ICSI and FET, 2015
28.1.2019 12
The number of donations
28.1.2019 13
Started treatments by age
28.1.2019 14
The number of newborns born after ART
28.1.2019 15
The number of newborns and the effect of ART
28.1.2019 16
How to measure quality in ART?
28.1.2019 17
The mean number of transferred embryos
28.1.2019 18
The proportion of single embryo transfers
28.1.2019 19
The number of multiple deliveries after ART
28.1.2019 20
The proportion of multiple deliveries after ART, %
28.1.2019 21
The proportion of treatments ending to a live birth
28.1.2019 22
Success rates by the number of transferred embryos in 2016
28.1.2019 23
IVF/ICSI success rates by clinic in 2016
28.1.2019 24
Proportion of IVF/ICSI single embryo transfers by clinic in 2016
28.1.2019 25
The proportion of premature births (<37 gw) and low birth weight children (<2500 g), %
28.1.2019 26
The mean number of embryos per a live born child
28.1.2019 27
Need for better data
▪ Current data collection is based on aggregated data.
▪ The ART legislation (2007)
– National statistics are based on aggregated data.
– Each clinic has to keep a register.
– For research purposes clinical data can be combined.
▪ Monitoring of quality in ART services is limited.
– Benchmarking between clinics cannot be done by using case-mix.
– No information on the number of treatments per woman/couple.
– No information on cumulative success rate.
– No information on the effectiveness of ART services, e.g. the high use of FET.
28.1.2019 28
Need for better data
▪ Possibilities:
– To start a new quality register: informed consent is required as well as more funding.
– To collect cycle-based data for research: no informed consent is required, but there are limitation how the data can be used.
– The parliament has received a proposal for a new legislation on secondary use of health care information (2019?). In the background document, the request to initiate an IVF-register has been mentioned.
28.1.2019 29