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Understanding the use and impact of the online community in a national quality improvement campaign
  1. Ingrid M Nembhard1,2,
  2. Alexander G Nazem3,
  3. Tashonna R Webster1,5,
  4. Yongfei Wang3,4,
  5. Harlan M Krumholz3,4,
  6. Elizabeth H Bradley1
  1. 1Yale University, School of Public Health/School of Medicine, New Haven, Connecticut, USA
  2. 2Yale University, School of Management, New Haven, Connecticut, USA
  3. 3Yale University, School of Medicine, New Haven, Connecticut, USA
  4. 4Yale-New Haven Hospital, Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA
  5. 5Center for Public Health and Health Policy, University of Connecticut, East Hartford, Connecticut, USA
  1. Correspondence to Ingrid M Nembhard, Yale University, 60 College Street, PO Box 208034, New Haven, CT 06520-8034, USA; ingrid.nembhard{at}


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.

  • Quality improvement
  • organisational learning
  • online systems
  • information sharing
  • national quality campaigns
  • collaborative
  • evidence-based medicine
  • healthcare quality improvement
  • organization

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  • Funding This work was funded by the Commonwealth Fund, the Patrick and Catherine Weldon Donaghue Medical Research Foundation, and the American College of Cardiology (ACC). The ACC and 38 other partner organisations that developed the D2B Alliance (listed at sponsored the D2B Online Community. The funders and sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the paper.

  • Competing interests None declared.

  • Ethics approval This study was conducted with the approval of the Yale University School of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.