Background:

The hospital discharge transition can be dangerous for patients with a high risk of failed follow‐up and adverse events. Moreover, about 20% of hospitalized Medicare patients are readmitted within 30 days of discharge. Although studies have documented reduced rates of read‐missions from interventions at individual hospitals, dissemination to larger cohorts is lacking, and the role of hospitalists is unclear. Project BOOST (Better Outcomes for Older Adults through Safe Transitions) was developed to help hospitals improve their discharge processes and reduce 30‐day readmission rates.

Methods:

Development of a Web‐based tool kit was overseen by an advisory board of nationally recognized experts in transitions of care. The tool kit focuses on key aspects of the hospital discharge transition including: (1) ensuring high‐risk patients are identified and specific interventions are offered to mitigate the risk of adverse events, (2) improving patient and family preparation for discharge including medication reconciliation, (3) optimizing the flow of information between hospital and outpatient physicians, and (4) ensuring appropriate follow‐up. Six pilot hospitals initiated implementation of this tool kit in 2008, each guided by a hospitalist mentor knowledgeable in quality improvement and care transitions. An additional 24 hospitals enrolled in 2009. Both cohorts began with a 2‐day conference orienting the participating hospital teams and connecting them with their mentor. Mentors subsequently communicated regularly with their sites via conference calls using a standardized approach with documentation via Web‐based forms and often made site visits. Enrolled hospitals participated in an online community consisting of a participant listserv, teleconferences, and webinars. To better understand the effectiveness of this national quality improvement project, we collected same‐hospital 30‐day readmission data for a BOOST intervention unit and a non‐BOOST control unit.

Results:

Of the 30 enrolled hospitals, 21 hospitals contributed data to the BOOST database to date. Data collection for 1‐year outcomes of Project BOOST is expected to close in March 2011. Presently, the database contains 730 unit‐months of data for BOOST units. At sites that have submitted data describing both the 6‐month period prior to BOOST implementation and the 6‐month period following BOOST implementation (n = 6), readmission rates fell from an average of 14.2% 6 months prior to implementation to 11.2% 6 months after implementation. Comparative data between BOOST units and site‐matched control units are anticipated for March 2011.

Conclusions:

Preliminary data indicate that hospitalist‐mentored implementation of Project BOOST was associated with reductions in 30‐day readmissions. Further spread will require an understanding of barriers that prevent its implementation at some hospitals.

Disclosures:

M. V. Williams ‐ Society of Hospital Medicine, funding support for Project BOOST; L. Hansen ‐ Society of Hospital Medicine, funding support for Project BOOST; J. L. Greenwald ‐ Society of Hospital Medicine, funding support for Project BOOST; E. Howell ‐ Society of Hospital Medicine, funding support for Project BOOST; L. Halasyamani ‐ none; D. Dressler ‐ Society of Hospital Medicine, funding support for Project BOOST; A. Vidyarthi ‐ Society of Hospital Medicine, funding support for Project BOOST; J. Nagamine ‐ Society of Hospital Medicine, funding support for Project BOOST; T. Budnitz ‐ Society of Hospital Medicine, funding support for Project BOOST