August 15 2013
Project BOOST: Preventing readmissions and improving care
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
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
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
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.