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QUARTERLY FOCUS ISSUE: PREVENTION/OUTCOMES: NEWS FROM THE NCDR

National Efforts to Improve Door-to-Balloon Time

Results From the Door-to-Balloon Alliance

Elizabeth H. Bradley, PhD^_*,_*, Brahmajee K. Nallamothu, MD, MPH, Jeph Herrin, PhD, Henry H. Ting, MD, MBA^||, Amy F. Stern, MHS^¶, Ingrid M. Nembhard, PhD^_*,#, Christina T. Yuan, MPH^_*, Jeremy C. Green, BA^_*, Eva Kline-Rogers, MS, RN^_**, Yongfei Wang, MS, Jeptha P. Curtis, MD, Tashonna R. Webster, MPH, MS^_*,, Frederick A. Masoudi, MD, MSPH, Gregg C. Fonarow, MD, John E. Brush, Jr, MD^|||| and Harlan M. Krumholz, MD, SM^_*,,,¶¶

^_* Section of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut
Health Services Research and Development Center of Excellence, VA Medical Center, Ann Arbor, Michigan
Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
^|| Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
^¶ National Quality Forum, Washington, DC
^# School of Management, Yale University, New Haven, Connecticut
^_** Division of Cardiology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
Center for Public Health and Health Policy, University of Connecticut, East Hartford, Connecticut
Division of Cardiology, Department of Medicine, Denver Health Medical Center and the Division of Cardiology and the Colorado Health Outcomes Program, Department of Medicine, University of Colorado at Denver and Health Sciences Center, Denver, Colorado
Department of Medicine, UCLA Medical Center, Los Angeles, California
^|||| Sentara Cardiovascular Research Institute, Norfolk, Virginia
^¶¶ Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut

Manuscript received September 28, 2009; revised manuscript received October 23, 2009, accepted November 1, 2009.

^_* Reprint requests and correspondence: Dr. Elizabeth H. Bradley, 60 College Street, New Haven, Connecticut 06520 (Email: elizabeth.bradley{at}yale.edu).

Objectives: 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.

Background: 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.

Methods: 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.

Results: By March 2008, >75% of patients had D2B times of 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).

Conclusions: The D2B Alliance reached its goal of 75% of patients with STEMI having D2B times within 90 min by 2008.

Key Words: acute myocardial infarction • hospitals • quality collaborative • quality improvement

Abbreviations and Acronyms   D2B = door-to-balloon   PPCI = primary percutaneous coronary intervention   STEMI = ST-segment elevation myocardial infarction

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