The design of the D2B: An Alliance for Quality, a novel campaign to improve D2B time, is described.

The D2B Alliance reached its goal of 75% of patients with STEMI having D2B times within 90 min by 2008.

Quality-improvement techniques can be implemented by CHWs to improve outcomes in community settings but these approaches require adaptation and additional mentoring support to be successful. More research is required to establish the effectiveness of this approach on processes and outcomes of care.

No abstract

Background The Door-to-Balloon (D2B) Alliance is a collaborative effort of more than 900 hospitals aimed at improving D2B times for ST–segment elevation myocardial infarction. Although such collaborative efforts are increasingly used to promote improvement, little is known about the types of health care organizations that enroll and their motivations to participate. Methods To examine the types of hospitals enrolled and reasons for enrollment, a cross-sectional study was conducted of 915 D2B Alliance hospitals and 654 hospitals that did not join the D2B Alliance. Data were obtained from the American Hospital Association’s Annual Survey of Hospitals and a Web-based survey completed by 797 enrolled hospitals (response rate, 87%). Chi-square statistics were used to examine statistical associations, and qualitative data analysis was used to characterize reported reasons for enrolling. Results Hospitals that enrolled in the D2B Alliance were significantly (p values < .05) more likely to be larger, nonprofit (versus for-profit), and teaching (versus nonteaching) hospitals. Earlier- versus later-enrolling hospitals were more likely to have key recommended strategies already in place at the time of enrollment. Improving quality and “doing the right thing” were commonly reported reasons for enrolling; however, hospitals also reported improving market share, meeting regulatory and accreditation requirements, and enhancing reputation as primary reasons for joining. Conclusions The findings highlight the underlying goals of organizations to improve their position in the external environment—including economic, regulatory, accreditation, and professional environments. Designing quality improvement collaborative efforts to appeal to these goals may be an important strategy for enhancing participation and, in turn, increasing the uptake of evidence-based innovations.

The impact of national quality campaigns may depend on both campaign design features and on the internal environment of participating hospitals.

As countries pursue UNAIDS’s 90-90-90 target for ending the AIDS epidemic, success is dependent on learning how to deliver effective care. We describe a learning network and mechanisms used to foster communication and sharing of ideas and results across 6 countries in the Partnership for HIV-Free Survival. The network used 2 forms of peer exchange, in-person and virtual, and a variety of knowledge management mechanisms to harvest and spread key learning. Key learning included valuable insights on how to design and convene a multicountry learning network, including top enablers of success and practical insights on the network’s value. The network was instrumental in accelerating learning about improving care. Our experience shows the value of creating a quality improvement–driven, multicountry learning network to accelerate the pace of improving care systems. Government ownership and adaptation of collaborative learning efforts to the country context must be considered when designing future networks.

Previous qualitative studies about antiretroviral therapy (ART) adherence have largely focused on patient experiences. Less is known about the perspective of health care providers -particularly in low-income countries -who serve as gatekeepers and influencers of patients' HIV care experiences. This study explored patients' and providers' perceptions of important ART adherence determinants. Interviews were conducted at HIV treatment sites in Tanzania and Uganda, with adult patients on ART (n=148), and with health care providers (n=49). Patients were asked about their experiences with ART adherence, and providers were asked about their perceptions of what adherence challenges are faced by their patients. All interviews were conducted in local languages; transcripts were translated into English and analyzed using a codebook informed by the social ecological model. Themes were examined across and within countries. Adherence-related challenges were frequently reported, but patients and providers did not often agree about the reasons. Many patients cited challenges related to being away from home and therefore away from their pill supply; and, in Uganda, challenges picking up refills (access to care) and related to food sufficiency/diet. Providers also identified these access to care barriers, but otherwise focused on different key determinants (for example, they rarely mentioned food/diet); instead, providers were more likely to mention alcohol/alcoholism, stigma, and lack of understanding about the importance of adhering. These findings suggest areas of opportunity for future research and for improving clinical care by aligning perceptions of adherence challenges, to deliver better-informed and useful ART counseling and support.