Safe patient transitions reduce hospital readmissions
29 July 2013
A program developed by the US Society of Hospital Medicine to
reduce the number of patients readmitted within 30 days has reduced
rehospitalisation by nearly 14%.
(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 the program, 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.
The average rate of 30-day
rehospitalisation in BOOST units was 14.7% prior to implementing the
program and 12.7% twelve months later, reflecting a reduction of
13.6%. Rehospitalisation 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.
"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, Ashish Jha, MD, MPH, of the Harvard
School of Public Health, noted that the study's findings suggest
only a small improvement among a very select group of hospitals.
"Hospitals will need to find ways to reduce readmissions, and
programs like BOOST, even when executed perfectly, will be necessary
but likely insufficient. Improving the quality of care transitions
is critically important. But to truly get to better outcomes for
older Americans, hospitals will need to think beyond their four
walls," he wrote.
In another accompanying editorial, Andrew Auerbach, MD, MPH, of
the UCSF School of Medicine, and his colleagues pointed to several
shortcomings, but they stated that "the authors provide the
necessary start down the road towards a fuller understanding of real
world efforts to reduce readmissions. The nuances and flaws of this
study provide ample fodder for others working in the field."
Hansen LO, Greenwald JL, Budnitz T, Howell, E, Halasyamani L,
Maynard G, Vidyarthi A, Coleman EA, Williams MV. Project BOOST:
Effectiveness of a Multihospital Effort to Reduce Rehospitalization;
Journal of Hospital Medicine, 2013, DOI: 10.1002/jhm.2054
Editorial: Auerbach et al. BOOST: Evidence Needing a Lift;
Journal of Hospital Medicine, 2013, DOI: 10.1002/jhm.2065
Editorial: Jha. BOOST and Readmissions: Thinking Beyond the Walls
of the Hospital; Journal of Hospital Medicine, 2013, DOI: