Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

Ingrid M. Nembhard

Subject Area(s)

Medicine, Organizational behavior, Communication


Research suggests that health care organizations struggle to implement evidence-based guidelines. In the wake of this observation, national quality improvement initiatives have increasingly sponsored online communities (OCs) in which organizations and professionals can seek guidance from their peers on the many challenges that accompany the shifts in practice caused by guideline adoption.

In this paper, I examine the effect of participation in an OC on hospitals' implementation of evidence-based guidelines. I hypothesize that hospitals whose staff utilize OCs are more successful at achieving guideline implementation, leading ultimately to greater clinical outcome improvement. This hypothesis was tested using data from the OC of the Door-to-Balloon Alliance (D2B), a national campaign that promoted the adoption of five evidence-based practices to reduce time to treatment in order to reduce morbidity and mortality related to ST-segment elevation myocardial infarction (STEMI). The improvement in door-to-balloon time of hospitals that participated in the OC (52%, n=378 of 731) was compared to that of hospitals that did not. There was positive correlation between OC use and door-to-balloon time improvement, however it was not statistically significant (p value>0.05).

In this paper, I review the literature on OCs and then use it to examine several potential reasons for why D2B OC use was not associated with improvement in door-to-balloon times. I conclude that the design of the D2B OC undermined its effectiveness. Therefore, I suggest that OCs cannot yet be rejected as a tool to accelerate guideline adoption and clinical outcome improvement. Greater attention must be devoted to their design.


This is an Open Access Thesis.

Open Access

This Article is Open Access