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A study is conducted to examine different hospital strategies associated with a faster door-to-balloon time during primary percutaneous coronary intervention. Results show that many specific hospital strategies are associated with a significant reduction in the door-to-balloon time during treatment.

Race and ethnicity differences in door-to-drug and door-to-balloon times for patients receiving primary reperfusion for ST-segment elevation myocardial infarction are estimated. The results revealed that a substantial portion of the racial and ethnic disparity in time to treatment was accounted for by the specific hospital to which patients were admitted, in contrast to differential treatment by race and ethnicity inside the hospital.

Previous studies indicate that African American elders are less likely to use institutional long-term care than whites. The purpose of this study was to examine whether an individual's intention to use home care may mediate the effect of race on the actual use of home care. This study was a prospective, longitudinal study of 208 Connecticut residents over age 65. Findings indicated that African American elders' use of home care is associated with their intention to use services, while white elders' use of home care is associated with need. This suggests that the factors that predict long-term care use differ for African American and white elders. Therefore, the traditional models of health services use may need to be expanded in order to explain patterns of use among nonwhite populations. [ABSTRACT FROM AUTHOR]

Background: National quality campaigns often sponsor online communities; however, little is known about whether and how organisations use these communities, and the impact of their use., Methods: We conducted a longitudinal study of the D2B Online Community, which was sponsored by the D2B Alliance, a campaign to improve heart attack care. We examined community use, helpfulness, and impact on care for 731 Alliance-hospitals. Our data sources were a hospital survey, the archive of messages sent and the National Cardiovascular Data Registry's time-to-treatment data., Results: About 52% of hospitals (n=378/731) studied used the online community, with 27% of hospitals (n=195) contributing messages to the online community, while 25% (n=183) were silent users. Silent users were hospitals that reported staff use of the online community, but their staff did not send any messages. In the vast majority of contributing hospitals, only one individual contributed messages to the community. Contributing individuals, mostly nurses (70%), sent a total of 1155 messages, with 36% of messages sent by 11 high-volume users (5%). Messages discussed techniques for improving performance, performance measurement issues, location and interpretation of expert guidance and how to manage staff role changes. We found no statistical association between community use and improved time-to-treatment; however, many users rated the community highly for helpfulness., Conclusion: Many organisations used the online community for information exchange and found it helpful, despite its lack of association with performance improvement, suggesting what benefits there are may not directly link to performance.

For this study, the authors conducted case studies of four varied clinical programs to learn key factors influencing the diffusion and adoption of evidence-based innovations in health care. They found that the success and speed of the adoption/diffusion process depend on: the roles of senior management and clinical leadership; the generation of credible supportive data; an infrastructure dedicated to translating the innovation from research into practice; the extent to which changes in organizational culture are required; and the amount of coordination needed across departments or disciplines. The translation process also depends on the characteristics and resources of the adopting organization, and on the degree to which people believe that the innovation responds to immediate and significant pressures in their environment.