Program reduces avoidable hospital readmissions

RECENT federal legislation in the United States imposes financial penalties on hospitals that experience excessive patient readmissions within 30 days. A new study* published today in the Journal of Hospital Medicine looks at the potential of a program designed to improve the discharge process and prevent avoidable rehospitalizations.

Developed by the Society of Hospital Medicine, Project BOOST (Better Outcomes by Optimizing Safe Transitions) Mentoring Program focuses on identifying patients at highest risk for readmissions, communicating discharge plans effectively, and ensuring close follow-up through phone calls and timely doctors’ appointments. An integral component is the use of physician mentors to facilitate implementation of BOOST tools at participating hospitals. To assess the effectiveness of BOOST, researchers studied hospitals varying in geography, size, and academic affiliation that implemented BOOST. While 30 hospitals had implemented the program when the study was initiated, only 11 were able to provide hospital unit–specific data for the study. Notably, hospitals received no funding to participate in BOOST.

The investigators found that the average rate of 30 day rehospitalization in BOOST units was 14.7% prior to implementing the program and 12.7% twelve months later, reflecting an absolute reduction of 2 percent and a relative reduction of 13.6 percent. Rehospitalization rates for similar hospital units that did not implement BOOST were 14.0% in the pre-intervention period and 14.1% in the post-intervention period. The average absolute reduction in readmission rates in BOOST units compared with other units was 2.0%, or a nearly 14% relative reduction.

“Our findings support that among the sites willing and able to share the outcome data required for the study, there was significant improvement,” said lead BOOST analyst Luke Hansen, MD, MHS, of the Northwestern University Feinberg School of Medicine. “There is more work to do to fully engage non-academic sites in quality improvement research like ours and to understand what makes for fertile ground for implementing changes included in the BOOST toolkit.”

“We are encouraged by our initial findings and learned substantially from this initial implementation and evaluation,” added BOOST Principal Investigator, Mark V. Williams, MD, MHM, of the Northwestern University Feinberg School of Medicine. “Subsequent Project BOOST collaboration with greater than 130 hospitals has been modified and bolstered to increase the intensity of the BOOST intervention,” he said.

In an accompanying editorial [1], Ashish Jha, MD, MPH, of the Harvard School of Public Health, noted that the study’s findinAir Jordan