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What Is the Experience of National Quality Campaigns? Views from the Field

Authors

  • Elizabeth H. Bradley,

    1. Division of Health Policy and Administration, Yale School of Public Health, 60 College Street, PO Box 208034, New Haven, CT 06520-8034
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    • Address correspondence to Elizabeth H. Bradley, Ph.D., Division of Health Policy and Administration, Yale School of Public Health, 60 College Street, PO Box 208034, New Haven, CT 06520-8034; e-mail: elizabeth.bradley@yale.edu. Ingrid M. Nembhard, Ph.D., is with the Division of Health Policy and Administration, Yale School of Public Health, and Yale School of Management, New Haven, CT. Christina T. Yuan, M.P.H., is with the Division of Health Policy and Administration, Yale School of Public Health, New Haven, CT. Amy F. Stern, M.H.S., is with the National Priorities Outreach Efforts, National Quality Forum, Washington, DC. Jeptha P. Curtis, M.D., is with the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT. Brahmajee K. Nallamothu, M.D., M.P.H., is with the Health Services Research and Development Center of Excellence, VA Medical Center, Ann Arbor, MI. John E. Brush, Jr., M.D., is with the Cardiology Consultants Ltd., Norfolk, VA. Harlan M. Krumholz, M.D., S.M., is with the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine; the Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine; Division of Health Policy and Administration, Yale School of Public Health; and the Center for Outcomes Research and Evaluation, Yale New-Haven Hospital, New Haven, CT.

  • Ingrid M. Nembhard,

    1. Division of Health Policy and Administration, Yale School of Public Health, and Yale School of Management, New Haven, CT
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  • Christina T. Yuan,

    1. Division of Health Policy and Administration, Yale School of Public Health, New Haven, CT
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  • Amy F. Stern,

    1. National Priorities Outreach Efforts, National Quality Forum, Washington, DC
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  • Jeptha P. Curtis,

    1. Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT
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  • Brahmajee K. Nallamothu,

    1. Health Services Research and Development Center of Excellence, VA Medical Center, Ann Arbor, MI
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  • John E. Brush Jr.,

    1. Cardiology Consultants Ltd., Norfolk, VA
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  • Harlan M. Krumholz

    1. Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine; the Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine; Division of Health Policy and Administration, Yale School of Public Health; and the Center for Outcomes Research and Evaluation, Yale New-Haven Hospital, New Haven, CT
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Abstract

Objective. To identify key characteristics of a national quality campaign that participants viewed as effective, to understand mechanisms by which the campaign influenced hospital practices, and to elucidate contextual factors that modified the perceived influence of the campaign on hospital improvements.

Data Sources. In-depth interviews, hospital surveys, and Health Quality Alliance data.

Study Design. We conducted a qualitative study using in-depth interviews with clinical and administrative staff (N=99) at hospitals reporting strong influence (n=6) as well as hospitals reporting limited influence (n=6) of the Door-to-Balloon (D2B) Alliance, a national quality campaign to improve heart attack care. We analyzed these qualitative data as well as changes in hospital use of recommended strategies reported through a hospital survey and changes in treatment times using Health Quality Alliance data.

Data Collection Methods. In-depth, open-ended interviews; hospital survey.

Principal Findings. Key characteristics of the national quality campaign viewed as enhancing its effectiveness were as follows: credibility of the recommendations, perceived simplicity of the recommendations, alignment with hospitals' strategic goals, practical implementation tools, and breadth of the network of peer hospitals in the D2B Alliance. Perceived mechanisms of the campaign's influence included raising awareness and influencing goals, fostering strategy adoption, and influencing aspects of organizational culture. Modifying contextual factors included perceptions about current performance and internal championship for the recommended changes.

Conclusions. The impact of national quality campaigns may depend on both campaign design features and on the internal environment of participating hospitals.

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