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  • August 15 2013

    Readmission prevention continues to be a topic of importance for health systems across the country. Optimizing care transitions, especially hospital discharge, is an essential component of any strategy to reduce readmissions. Mark Williams, MD, professor and chief of the Division of Hospital Medicine at Northwestern University Feinberg School of Medicine, is principal investigator for the team implementing and refining Project BOOST, a program designed to optimize the hospital discharge process, reducing adverse events and ultimately readmissions. Recently, we announced that we would be integrating the Project BOOST toolkit into our EHR system, so we took the opportunity to speak with Dr. Williams about Project BOOST and the work his team is doing to prevent readmissions and improve care.

    Can you give us a brief introduction to Project BOOST?

    BOOST stands for Better Outcomes by Optimizing Safe Transitions. It’s a quality improvement toolkit and program that aims to help hospitals optimize the discharge process and thus reduce adverse events that might otherwise happen during this care transition. One of the main goals of the project is to reduce hospital readmissions.

    How is Project BOOST different from other readmission prevention programs out there today?

    I think, very importantly, BOOST is unique in that it uses a mentored implementation approach to effectively integrate the toolkit into a hospital’s discharge process. What I mean by mentored implementation is that physicians with expertise in quality improvement and care transitions work directly with hospitals and mentor their quality improvement teams to implement BOOST tools to optimize their discharge process. We firmly believe this approach is why the toolkit is successfully implemented by hospitals yielding reductions in readmission rates.

    Can you share a little bit about the evolution of Project BOOST’s focus?

    The program was originally funded by The John A. Hartford Foundation with a $1.4 million grant to enable development of the toolkit and piloting of it with 30 hospitals. We learned a tremendous amount from that, one of the key learnings being the need to apply the toolkit to all patients being discharged from the hospital, rather than just older patients, which was the original focus of the program.

    Is there a specific aspect of the BOOST program that focuses on the discharge process for pediatric patients?

    There’s a group of pediatric hospitalists who took the BOOST toolkit and modified it for younger patients and their families. This program, Pedi-BOOST, should be coming out later this summer. We’re hopeful that children’s hospitals will begin to implement this to optimize their discharge process. Interestingly, there are a growing number of complex pediatric patients who require very intense therapy. Having an organized approach to managing these patients’ transitions is important to optimize patient safety.

    You mentioned that you’ve done some pilot implementations of Project BOOST. What results have you seen from those implementations?

    We just published results of our initial pilot of Project BOOST in the most recent issue of the Journal of Hospital Medicine. Our results showed that we reduced hospital readmissions in the units that implemented the toolkit compared to control units in the same hospital that did not. Notably, those control units did not have a change in their readmission rate whatsoever, while we saw a 14 percent reduction in readmissions in the units that implemented the BOOST tools.

    Why is integrating Project BOOST processes into the EHR an important step in the program’s development?

    This is not just an important step, it’s, in my opinion, a critical one. As we were implementing Project BOOST, we saw in multiple hospital settings that as they transitioned electronic records from paper, they needed the BOOST tools available to them (Project BOOST was solely paper-based before). One of the key pieces of Project BOOST, the risk assessment tool, works best if integrated into the EHR. This will increase the likelihood that as hospital staff identify patients at risk for readmission, they can then connect through the EHR to risk-specific interventions to mitigate the impact of that risk and reduce the likelihood that the person will be readmitted. We’re extremely excited that these tools will be a part of the EHR so that those hospitals using Cerner’s system can directly integrate the BOOST tool into their workflow.

    Another example is the patient-centered discharge instructions. Having that integrated into the EHR so that nurses, physicians and pharmacists can provide information in a format that’s easily understandable will lead to increased comprehension of that information for both the patient and the caregiver(s).

    What’s on the horizon for Project BOOST as you work to improve the system?

    We’ve implemented Project BOOST in nearly 40 hospitals across the state of Illinois, and we have preliminary data from our first cohort here in Illinois. This was a modified, intensified version of Project BOOST, if you will. What we saw was a 25 percent drop in readmission rates among intervention units compared to control units. We have a new toolkit coming out this fall, at the latest, enhanced based on what we’ve learned from prior implementations. There’s a remarkable focus on enhancing care transitions from CMS and other groups, and I’m looking forward to working with other hospitals to implement the tool.

    We’re kicking off another cohort for Project BOOST in October. You can sign up for that on our website, as well as download the original BOOST toolkit and learn more about the program. You can also contact us directly via the website as well. 

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