With the Affordable Care Act’s focus on reducing hospital readmissions, the Society of Hospital Medicine’s Project BOOST is gaining attention from hospitals and payers as a possible model for improving hospital care and the discharge process.
Project BOOST (Better Outcomes for Older Adults Through Safe Transitions), launched by the Society of Hospital Medicine in December 2008, aims to reduce unnecessary readmissions and improve overall quality of care by better identifying patients who are the most at risk for returning to the hospital. The program uses a tool kit and mentors to guide hospital staff as they identify patients most in need of extra care as they prepare to leave the hospital. For example, the interventions include calling high-risk patients within 72 hours after hospital discharge to see if they have questions about their medications.
"These follow-up calls can identify and catch a lot of things that are happening or not happening," said Dr. Janet Nagamine, a hospitalist at Kaiser Permanente Hospital in Santa Clara, Calif., and a coinvestigator with Project BOOST. She chairs the California BOOST Collaborative.
Dr. Janet M. Nagamine
Dr. Nagamine said the Project BOOST team has learned a lot since starting in 2008 and has begun to work with large payers to try to get those lessons applied in more places. They have already shared their results and lessons learned with officials from the Centers for Medicare and Medicaid Services. Medicare officials are currently working on implementing provisions of the Affordable Care Act that call for decreasing Medicare payments to hospitals with higher-than-expected readmission rates for certain conditions starting in 2013.
So far about 80 sites have enrolled in Project BOOST and pay a fee to work with a mentor for a year to implement the program’s interventions. In addition, more than 1,600 sites have downloaded the tool kit for free. And the overall results look promising. Preliminary data from some of the first sites to implement Project BOOST show that they were able to reduce their 30-day readmission rates from 14.2% before implementation to 11.2% after implementation, a 21% reduction in 30-day all-cause readmission rates.
One of the biggest challenges in successfully implementing Project BOOST is finding the time to devote to it, Dr. Nagamine said. "Nobody in the hospital these days is looking for more to do and people are quite resistant to change," she said.
The hospitals that have the greatest success in implementing the program are the ones where the senior leadership makes it a priority and gives the frontline staff the time and resources to do it, in part by freeing them of some of their other responsibilities. "The sites that keep adding more work on top of your already full plate don’t tend to do as well," Dr. Nagamine said.
The mentors who work with the BOOST sites also try to keep hospital staff from getting off track if part of the project hits a snag, Dr. Nagamine said. For instance, some hospitals might try to incorporate the BOOST tool into a new electronic health record system. If that system is going live for the first time it can slow down the BOOST initiative. In situations like that, the mentors have been working with the hospital staff to figure out what other parts of the project they can work on to make sure they continue to make progress, she said.
For hospitals that haven’t enrolled in Project BOOST but are looking to implement the tools on their own, Dr. Nagamine advised them to take it slowly. The first thing to do is to get buy-in from senior leadership at the hospital, she said. Sometimes frontline staff and case managers will see the tool and try to jump right into implementation, she said, but there’s a lot of prework that goes into making this successful. "That’s something that people sometimes forget." She suggested that clinicians instead take a look at the baseline data on readmissions and come up with a plan for what they want to do and what level of resources they will need. Then they can take that plan to the hospital leadership, she said.
Project BOOST was developed with support from The John A. Hartford Foundation. The Blue Cross Blue Shield Association of Michigan and the California Health Care Foundation have also provided funding for the program.