Contemporary evidence: baseline data from the D2B Alliance.
BACKGROUND
Less than half of U.S. hospitals meet guidelines for prompt treatment of ST-segment elevation myocardial infarction (STEMI). The Door-to-Balloon (D2B) Alliance is a collaborative effort of more than 900 hospitals committed to implementing a set of evidence-based strategies for reducing D2B time. This study presents data on (1) the prevalence of evidence-based strategies in U.S. hospitals that participated in the D2B Alliance and (2) identifies key hospital characteristics associated with their use.


METHODS
We conducted a cross-sectional study of U.S. hospitals that joined the D2B Alliance through a Web-based survey about their current practices for patients with STEMI who received primary percutaneous coronary intervention (PCI). We used multivariate logistic regression to identify hospital characteristics associated with use of each strategy.


RESULTS
Of the 915 U.S. hospitals enrolled in the D2B Alliance as of June 2007, 797 (87%) completed the survey. Only 30.4% of responding hospitals reported employing at least 4 of the 5 key strategies (emergency medicine activates catheterization laboratory, single-call activation, expectation that catheterization team is available in the laboratory within 20-30 minutes after page, prompt data feedback on D2B times, use of pre-hospital electrocardiograms to activate the laboratory while the patient is en route to the hospital); 9.3% employed none of the strategies. There was no clear pattern of correlation between hospital characteristics and reported strategies.


CONCLUSIONS
As of 2007, many hospitals had implemented few of the key strategies to reduce D2B time, suggesting substantial opportunity to improve care for patients with STEMI.
Bradley
Elizabeth H
EH
Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, Connecticut, USA. elizabeth.bradley@yale.edu
Nallamothu
Brahmajee K
BK
Stern
Amy F
AF
Byrd
Jason R
JR
Cherlin
Emily J
EJ
Wang
Yongfei
Y
Yuan
Christina
C
Nembhard
Ingrid
I
Brush
John E
JE
Krumholz
Harlan M
HM