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Amid persistent evidence that many patients do not receive guideline-based care, national quality campaigns have developed to motivate widespread adoption of evidence-based practices to improve quality of care. Recent examples include the 100,000 Lives and 5 Million Lives Campaigns sponsored by the Institute for Healthcare Improvement (Gosfield and Reinertsen 2005; Berwick et al. 2006; McCannon, Hackbarth, and Griffin 2007; American Heart Association; 2009), and the Door-to-Balloon (D2B) Alliance for Quality led by the American College of Cardiology (Krumholz et al. 2008). Although there is some debate regarding the magnitude of impact (Wachter and Pronovost 2006), evidence (Berwick et al. 2006; McCannon et al. 2006; Bradley et al. 2009a;) suggests that these campaigns can have measurable impact in increased adherence to guidelines and potentially marked reductions in preventable deaths. Despite the widespread participation by hospitals in such national quality campaigns, we know little about users' perspectives about what makes such campaigns more effective or less effective. Previous research has reported views of network sponsors and researchers concerning characteristics of effective learning networks (Ovretveit 2002; Ovretveit et al. 2002; Wilson, Berwick, and Cleary 2003; Ayers et al. 2005; McCannon and Perla 2009;), but these reports have not examined participant views. Nevertheless, participant views are important for understanding the characteristics of campaigns that enhance their effectiveness, for identifying why campaigns might be effective, and for describing the conditions under which campaigns may be more effective or less effective. This deeper understanding of campaigns may shed light into the process of effective dissemination of evidence-based practices to promote quality of care. Accordingly, we sought to understand the influence of a national quality campaign, the D2B Alliance, from the participants' perspective. The D2B Alliance was a national quality campaign, sponsored by the American College of Cardiology and 38 other professional organizations and agencies, to disseminate evidence-based practices in reducing delays to between-hospital presentation and percutaneous coronary intervention (PCI), or balloon angioplasty, for patients with ST-segment elevation myocardial infarction (STEMI). The D2B Alliance was an open and free campaign that enrolled more than 1,000 U.S. hospitals in its first year (Krumholz et al. 2008). Hospitals enrolled by having a letter signed by the senior administrator committing to the goal of the D2B Alliance, which was for 75 percent of patients with STEMI treated with PCI to receive therapy within 90 minutes of hospital arrival, the D2B time target set by national guidelines. The D2B Alliance promoted the implementation of evidence-based strategies (Bradley et al. 2006; Bradley et al. 2009a) for reducing D2B time by disseminating a toolkit and a change package as well as providing open access to webinars, an online community, and a mentor network. We addressed the following questions pertinent to national quality campaigns with our research. What characteristics of the campaign are viewed by participants as most effective? What are the mechanisms by which the campaign influences outcomes? And what are the contextual factors that modify the effectiveness of the campaign? Such information can be used by researchers, policy makers, and practitioners to anticipate the circumstances under which campaigns might be effective dissemination strategies and to include design features based on evidence about what participants view as most effective. |
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