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Program Holds Promise for Reducing Avoidable Hospital Readmissions

Physician mentoring reduces 30-day readmission rates (July 22)

Recent federal legislation imposes financial penalties on hospitals that experience excessive patient readmissions within 30 days. A new study published in the Journal of Hospital Medicine looks at the potential of a program designed to improve the discharge process and to prevent avoidable rehospitalizations.

Developed by the Society of Hospital Medicine, the Project BOOST (Better Outcomes by Optimizing Safe Transitions) Mentoring Program focuses on identifying patients at highest risk for readmissions, on communicating discharge plans effectively, and on ensuring close follow-up through phone calls and timely doctors’ appointments. An integral component of the program is the use of physician mentors to facilitate implementation of BOOST tools at participating hospitals.

To assess the effectiveness of BOOST, researchers studied hospitals varying in geography, size, and academic affiliation that implemented the program. While 30 hospitals had implemented BOOST when the study was initiated, only 11 were able to provide hospital unit–specific data for the study.

The investigators found that the average rate of 30-day rehospitalization in BOOST units was 14.7% prior to implementing the program and 12.7% 12 months later, reflecting an absolute reduction of 2% and a relative reduction of 13.6%. Rehospitalization rates for similar hospital units that did not implement the BOOST program were 14.0% in the pre-intervention period and 14.1% in the post-intervention period. The average absolute reduction in readmission rates in BOOST units compared with other units was 2.0%, or a nearly 14% relative reduction.

In an accompanying editorial, Ashish Jha, MD, MPH, of the Harvard School of Public Health, noted that the study’s findings suggest only a small improvement among a very select group of hospitals. “Hospitals will need to find ways to reduce readmissions, and programs like BOOST, even when executed perfectly, will be necessary but likely insufficient. Improving the quality of care transitions is critically important. But to truly get to better outcomes for older Americans, hospitals will need to think beyond their four walls,” he wrote.

In another editorial, Andrew Auerbach, MD, MPH, of the UCSF School of Medicine, and his colleagues pointed to several shortcomings, but they stated that “the authors provide the necessary start down the road towards a fuller understanding of real world efforts to reduce readmissions. The nuances and flaws of this study provide ample fodder for others working in the field.”

Source: Wiley; July 22, 2013.

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