Background:
Reducing readmissions increasingly captures the attention of hospitals, yet little data exist supporting effective hospital strategies. Project BOOST (Better Outcomes by Optimizing Safe Transitions) is a patient‐centered multicomponent intervention created to enhance the hospital discharge transition. Integration of BOOST tools into the discharge process at a hospital is facilitated by physician‐mentored implementation (PMI) to provide expertise in (1) care transitions, (2) quality improvement (QI), and (3) outside support for internal change.
Methods:
We enrolled 14 hospitals from Illinois in Project BOOST beginning with a face‐to‐face interactive 2‐day training session that provided instruction on BOOST interventions and exercises in QI methods. Physician mentors conducted monthly mentor teleconference and in‐time e‐mail communication. During teleconference calls, mentors coached QI teams on the use of Plan‐Do‐Study‐Act cycles (PDSAs), tailoring of an intervention to the local culture, measurement of the effect of the intervention, and incorporation of lessons learned. Mentors also conducted 1 or more site visits to meet with senior leadership and the QI team to garner support and engage medical staff in BOOST implementation. A midyear implementation survey was conducted to learn about hospitals' engagement. Hospitals were encouraged to identify a comparison unit with a similar setting and patient population to an intervention BOOST unit. Thirty‐day readmission rate data were collected monthly on BOOST and comparison units. The Cochran–Armitage test of trend was calculated to determine the significance of readmission rate changes.
Results:
The midyear implementation survey showed 79% of BOOST QI teams implemented comprehensive patient readmission risk assessment, 57% implemented the discharge checklist, 79% started to use teach‐back for patient/family education, 79% established mechanisms to assure information was available to subacute providers at the time of discharge, and all hospitals conducted follow‐up phone calls. BOOST and comparison unit data were available from 6 hospitals. BOOST units experienced a 24.7% relative reduction (from 15.85% to 11.93%) in 30‐day readmission rates and a significant downward trend over time (P = 0.0092). Over the same period, the 30‐day readmission rate in comparison units remained flat (P = 0.2664).
Conclusions:
The PMI model is a successful approach to implement Project BOOST and improve care transitions, yielding reduced readmission rates.
