The Door-to-Balloon Alliance for Quality: Who Joins National Collaborative Efforts and Why?

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.

2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

“…105 A longitudinal study of hospitals participating in the NCDR CathPCI Registry demonstrated that patients treated in hospitals that had been enrolled in the D2B Alliance for ≥3 months were significantly more likely to have D2B times of ≤90 minutes than patients treated in nonenrolled hospitals. 105 In a similar manner, the AHA launched "Mission: Lifeline" in 2007 to improve health system readiness and response to STEMI, 106,107 with a focus on the continuum of care from EMS activation to primary PCI. Patients may present directly by private transport to a PCI-capable hospital, in which case all medical care occurs in a single center responsible for optimizing door-to-device times.…”

Impact of Sex and Contact‐to‐Device Time on Clinical Outcomes in Acute ST‐Segment Elevation Myocardial Infarction—Findings From the National Cardiovascular Data Registry

“…In the past, there had been a focus on achieving a door‐to‐balloon (D2B) time ≤90 minutes, ie, time of hospital arrival to primary PCI 3. D2B time has proven to be a fair metric, and strategies such as prehospital transmission of ECGs have been designed around meeting such a benchmark with moderate success 4, 5, 6, 7. Studies have shown that reducing D2B times beyond this 90‐minute benchmark has not resulted in decreased mortality; notably, mortality from STEMI has plateaued with further reductions in D2B.…”

Global Tracheostomy Collaborative: The Future of Quality Improvement Strategies

“…Accordingly, quality improvement collaboratives have been used to address a myriad of clinical problems, including maternity and perinatal care, asthma, and adult congestive heart failure. Aside from aiming for world-class care that is safe and efficient, hospitals may participate to meet less measureable parameters, such as achieving regulatory and accreditation standards, optimizing market share, enhancing revenue, and improving the organizational culture of patient safety and quality at the single institution level [22].…”