Although substantial effort has been made to understand uptake of evidence‐based practice among participants in national quality campaigns, little attention has been directed toward hospitals that elect not to join these efforts.


We conducted a prospective cohort study using a sample of 365 hospitals first surveyed in 2005 before the existence of a national quality improvement campaign, the D2B Alliance, and subsequently surveyed in 2008 using the same questionnaire. Hospitals reported use of strategies recommended by the D2B Alliance as well as use of resources available through the D2B Alliance. Logistic regression was used to compare rates of strategy use and Alliance resource use in 2008.


Use of recommended strategies to reduce door‐to‐balloon time significantly increased between 2005 and 2008 in bi‐variate analysis [single‐call catheterization laboratory activation increased from 14% to 35% (P < 0.0001), emergency department catheterization laboratory activation increased from 23% to 59% (P < 0.0001), 30‐minuie arrival for catheterization laboratory staff increased from 68% to 91% (P < 0.0001), prompt data feedback increased from 42% to 73% (P < 0.0001), and prehospital ECG transmission use increased from 9% to 41 % (P < 0.0001)]. In logistic regression analysis, odds of adopting recommended strategies were not significantly different when enrolled hospitals were compared to nonenrolled hospitals [single‐call activation OR 0.80 (95% Cl 0.61–1.94), emergency department activation OR 1.08 (95% Cl 0.42–1.53), 30‐minute arrival expectation OR 0.75 (95% Cl 0.23–2.43), prompt data feedback OR 1.38 (95% Cl 0.74–2.59), and prehospital ECG use OR 1.35 (95% Cl 0.73–2.47)]. Eighty‐five percent of enrolled hospitals reported use of any D2B Alliance resource compared with 52% of nonenrolled hospitals. In logistic regression analysis, use of Alliance resources was significantly higher among enrolled hospitals for most available resources [Alliance Web site use OR 3.79 (95% Cl 1.87–7.71), Alliance newsletter use OR 7.62 (95% Cl 3.40–17.18), Alliance webinar use OR 3.09 (95% Cl 1.50–6.38), use of the Alliance online community OR 7.36 (95% Cl 3.10–17.67), use of the Alliance tool kit for strategy implementation OR 2.82 (95% Cl 1.36–5.84), attendance at Alliance sessions at the American College of Cardiology annual meeting OR 1.67 (95% CI .75– 3.74), and use of the Alliance mentor network OR 5.74 (95% Cl .70 to 47.35)].


Significant increases in the use of performance improvement strategies recommended by the D2B Alliance have been observed in both enrolled and nonenrolled hospitals. A possible reason for similar increases is herd effects based on competitive pressure of a high‐profile quality campaign with spillover use of materials by nonenrolled hospitals.

Author Disclosure:

L. Hansen, none; J. Ibrahim, none; I. Nembhard, none; S. Busche, none; C. Yuan, none; H. Krumholz, none; E. Bradley, none.