Project holds promise for reducing avoidable rehospitalizations

A program developed by the Society of Hospital Medicine and in use by 140 hospitals nationwide has the potential to improve the discharge process and prevent avoidable rehospitalizations, according to a new study published in the Journal of Hospital Medicine.

According to Luke Hansen, study author and assistant professor at the Feinberg School of Medicine at Northwestern University, Project BOOST (Better Outcomes by Optimizing Safe Transitions) is a mentoring program that focuses on identifying patients at the highest risk for readmissions, communicating discharge plans effectively and ensuring close follow-up through phone calls and doctors’ appointments. The hospitals involved in BOOST range from large academic medical centers to small rural or community hospitals, Hansen said.

Hansen said in order to assess the effectiveness of BOOST, he and his fellow 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 back in 2010, only 11 were able to provide hospital unit-specific data for the study.

The researchers found that the average rate of 30-day rehospitalizations in BOOST units was 14.7 percent prior to implementing the program and 12.7 percent a year later, reflecting an absolute reduction of 2 percent and a relative reduction of 13.6 percent. The average absolute reduction in readmission rates in BOOST units compared with other units was 2.0 percent, or a nearly 14 percent relative reduction.

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The BOOST program includes a discharge checklist for physicians and nurses, patient discharge instructions that are “very patient-friendly and readable,” user-friendly medication instructions and follow-up phone calls within 48 hours, said Hansen, who serves as a mentor in the BOOST program.

“With patient discharge instructions, historically we’ve been giving them the ‘New York Times’ version, but what they really need is the ‘USA Today’ version of instructions,” he said.

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One of the most important components of the program is the use of physician mentors to facilitate the implementation of BOOST at the participating hospitals – a component that has only become more important now that hospitals are being penalized financially for excessive patient readmissions within 30 days for certain conditions, Hansen said.

“The business case for reducing readmissions has gotten much easier since we started this program because of the readmission penalties and that the scale of the penalties will grow,” he said. “It started with the Centers for Medicare & Medicaid incentivizing to reduce avoidable readmissions, but I think other payers will begin to do this as well.”

“Our goal is to avoid the emotional and social cost of avoidable readmissions, and there may be financial implications or there may not be,” he added. “On a system level, it’s always cheaper to take care of patients outside the hospital than in.”

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