Understanding the use and impact of the online community in a national quality improvement campaign.

BACKGROUND: National quality campaigns often sponsor online communities; however, little is known about whether and how organisations use these communities, and the impact of their use. METHODS: We conducted a longitudinal study of the D2B Online Community, which was sponsored by the D2B Alliance, a campaign to improve heart attack care. We examined community use, helpfulness, and impact on care for 731 Alliance-hospitals. Our data sources were a hospital survey, the archive of messages sent and the National Cardiovascular Data Registry's time-to-treatment data. RESULTS: About 52% of hospitals (n=378/731) studied used the online community, with 27% of hospitals (n=195) contributing messages to the online community, while 25% (n=183) were silent users. Silent users were hospitals that reported staff use of the online community, but their staff did not send any messages. In the vast majority of contributing hospitals, only one individual contributed messages to the community. Contributing individuals, mostly nurses (70%), sent a total of 1155 messages, with 36% of messages sent by 11 high-volume users (5%). Messages discussed techniques for improving performance, performance measurement issues, location and interpretation of expert guidance and how to manage staff role changes. We found no statistical association between community use and improved time-to-treatment; however, many users rated the community highly for helpfulness. CONCLUSION: Many organisations used the online community for information exchange and found it helpful, despite its lack of association with performance improvement, suggesting what benefits there are may not directly link to performance.

The door-to-balloon alliance for quality: who joins national collaborative efforts and why?

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.