title: The door-to-balloon alliance for quality: who joins national collaborative efforts and why?
abstract: 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.
authors.affiliation: Health Management Program, Yale University School of Medicine, New Haven, Connecticut, USA. elizabeth.bradley@yale.edu
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.forename: Amy F
authors.initials: AF
authors.lastname: Stern
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Cherlin
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: Jason R
authors.initials: JR
authors.lastname: Byrd
authors.forename: Erika L
authors.initials: EL
authors.lastname: Linnander
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Nazem
authors.forename: John E
authors.initials: JE
authors.lastname: Brush
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000592:standards*; D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational; D055317:Evidence-Based Practice; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D011785:Quality Assurance, Health Care / Q000379:methods*