National Efforts to Improve Door-to-Balloon Time: Results from the D2B Alliance

Section of Health Policy and Administration, Yale School of Public Health, New Haven, CT, USA.
Journal of the American College of Cardiology (Impact Factor: 16.5). 12/2009; 54(25):2423-9. DOI: 10.1016/j.jacc.2009.11.003
Source: PubMed


The purpose of this study was to determine if enrollment in the Door-to-Balloon (D2B) Alliance, a national quality campaign sponsored by the American College of Cardiology and 38 partner organizations, was associated with increased likelihood of patients who received primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) being treated within 90 min of hospital presentation.
The D2B Alliance, launched in November 2006, sought to achieve the goal of having 75% of patients with STEMI treated within 90 min of hospital presentation.
We conducted a longitudinal study of D2B times in 831 hospitals participating in the National Cardiovascular Data Registry (NCDR) CathPCI Registry, April 1, 2005, to March 31, 2008.
By March 2008, >75% of patients had D2B times of < or = 90 min, compared with only about one-half of patients with D2B times within 90 min in April 2005. Trends since the launch of the D2B Alliance showed that patients treated in hospitals enrolled in the D2B Alliance for at least 3 months were significantly more likely than patients treated in nonenrolled hospitals to have D2B times within 90 min, although the magnitude of the difference was modest (odds ratio: 1.16; 95% confidence interval: 1.07 to 1.27).
The D2B Alliance reached its goal of 75% of patients with STEMI having D2B times within 90 min by 2008.

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Available from: Jeremy Craig Green, Oct 08, 2014
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    • "Previous North American studies that monitored guideline adherence have successfully identified associated factors [10, 16, 28], after which targeted quality improvement efforts could be applied. These efforts increased the likelihood that patients were treated on time with PCI [29], risk scores were documented [30] and the recommended discharge medication was prescribed [31]. Therefore the monitoring of guideline adherence as the foundation for targeted quality improvement efforts seems promising. "
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    • "To explore the potential parallels between spread of HIV among cells and spread of innovation among complex human health systems, we have chosen a recent example of successful spread: hospital practices to promote prompt ‘door-to-balloon time’ by reducing delays from hospital presentation to percutaneous coronary intervention (PCI) for patients with STEMI [18, 19]. In 2005, less than half of US patients with STEMI had door-to-balloon times within the national guideline of 90 min [18, 20], even though prompt treatment is critical for survival of patients with STEMI [21]. "
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