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Discharge improvement

From: The Hospitalist, July 2011

Project BOOST helps hospitals provide safer transitions for older adults

by Brendon Shank

If you’re a hospitalist interested in reducing readmissions in your hospital, the time to act is now.

Project BOOST (Better Outcomes for Older Adults through Safe Transitions), SHM’s groundbreaking program designed to help hospitals reduce unplanned readmissions, is now accepting applications for two new cohorts: one national and another specific to California. The deadline for applications is August 1.

Now with 85 sites as part of the national community, Project BOOST will introduce new sites across the country in the fall. In addition to the national cohort, Project BOOST will also establish a new cohort in California, with discounted tuition through grants from three healthcare groups in the state.

“It’s a great time to apply,” says Stephanie Rennke, MD, assistant clinical professor of medicine at the University of California San Francisco Medical Center. “We are at the cusp of a lot of big changes in health reform. The time to address readmissions is now. Hospitals will have to address this, and BOOST is one way to do that.”

Stephanie Rennke, MDHospitals need to realize healthcare reform is coming. Not only is reducing readmissions the right thing to do, it will also have a financial impact for hospitals that don’t address it.
—Stephanie Rennke, MD, assistant clinical professor of medicine, University of California San Francisco Medical Center

Applications are submitted online (www.hospitalmedicine.org/boost) and evaluated based on whether improving discharge and care transitions is a high priority at the institution. Applications must be accompanied by a letter of support from an executive sponsor within the applicant’s hospital.

Once accepted into the program, BOOST participants pay a tuition fee of $28,000. Thanks to the support of the California HealthCare Foundation, the L.A. Care Health Plan, and the Hospital Association of Southern California, sites in California are eligible for reduced tuition based on site location and availability of funds.

For Dr. Rennke, the link between healthcare reform and readmissions is clear, along with the repercussions for hospitals. Most notably, the discharge process affects multiple quality issues, including “patient satisfaction, provider satisfaction and improving communication from hospital to home.”

“Hospitals need to realize healthcare reform is coming,” says Dr. Rennke, who previously served as a Project BOOST site team member and now works as a BOOST mentor. “Not only is reducing readmissions the right thing to do, it will also have a financial impact for hospitals that don’t address it. … It’s going to be of paramount importance to address the discharge process.”

National Growth

Since it was initially developed through a grant from the John A. Hartford Foundation, Project BOOST has spread to hospitals across the country and received widespread attention throughout the healthcare community.

At the time of Project BOOST’s inception in 2008, readmissions already were an intractable and costly issue for hospitals. The next year, research coauthored by Project BOOST principal investigator Mark V. Williams, MD, FHM, and published in the New England Journal of Medicine revealed that unplanned readmissions cost Medicare $17.4 billion annually.

Project BOOST’s pilot cohort consisted of six hospital sites. The program’s growth accelerated quickly, and it soon added another 24 sites and, later, two statewide programs in Michigan and Illinois.

The popularity of Project BOOST among hospitals has captured the attention of media and other organizations as well:

  • This year, Kaiser Health News featured the work of Atlanta’s Piedmont Hospital to reduce readmissions using Project BOOST in an article focusing on the impact of healthcare reform laws on hospital readmissions.
  • The Bassett Healthcare Network, a Project BOOST site in upstate New York, has earned the Hospital Association of New York State’s prestigious 2011 HANYS Pinnacle Award for Quality and Safety for the group’s care-transition work. The award was presented to Bassett Healthcare Network chief executives in June.
  • In California, the Kaiser Permanente West LA BOOST Team was recognized with an award from Dr. Benjamin Chu, president of Southern California Kaiser Foundation Health Plan.
  • In December 2010, Dr. Williams and hospitalist Matthew Schreiber, CMO of Piedmont Hospital, shared their experiences with Project BOOST at a national conference hosted by the Centers for Medicare & Medicaid Services (CMS).
SHM Project BOOST Sites
SHM Project BOOST Sites

The Project BOOST Process

Once a site is accepted as a Project BOOST site, the site leader receives an information package and access to the Project BOOST online repository for recording and uploading readmission data. Then, each Project BOOST cohort performs an in-person conference. Networking and personal interaction are an important part of sharing challenges and successes in reducing readmissions. The conference also includes training on root-cause analysis and process mapping, a required step for application of the new Community Based Care Transitions Program (CCTP), part of the Affordable Care Act.

Each site leader is assigned a Project BOOST mentor, a national expert on reducing readmissions to the hospital. The mentor conducts a site visit to the hospital to meet the entire team in person and better understand the discharge challenges first-hand.

Over the course of the year, through regularly scheduled telephone calls, the mentor works with the Project BOOST team to best apply the program to the needs of the specific hospital. Mentors also help answer questions related to project planning, toolkit materials, data collection, implementation, and analysis.

In Dr. Rennke’s case, the process helped augment and guide UCSF’s current discharge program. Having multiple team members from different disciplines made distributing the work and implementation easier.

“Overall, we knew this was going to be doable because we incorporated Project BOOST into an already existing discharge process,” Dr. Rennke says.

Readmissions in the Crosshairs

The impacts of preventable readmissions on patient safety and efficiency of care in the hospital have made the issue a heated one in public policy. Earlier this year, the U.S. Department of Health and Human Services announced the creation of Partnership for Patients, a $1 billion initiative to address “quality, safety, and affordability of healthcare for all Americans.” SHM was one of the first medical societies to sign on to the “Partnership for Patients Pledge.”

One of the partnership’s two major goals is to reduce hospital readmissions by 20%. According to the Partnership for Patients website, “achieving this goal would mean more than 1.6 million patients would recover from illness without suffering a preventable complication requiring rehospitalization within 30 days of discharge.”

The government is backing up this goal with funding for hospitals with concrete plans to reduce readmissions. Under the Affordable Care Act of 2010—commonly known as the healthcare reform law—Medicare created the five-year CCTP earlier this year. The program provides $500 million to collaborative partnerships between hospitals and community-based organizations to implement care-transition services for Medicare beneficiaries, many of whom are at high risk of readmission.

To Dr. Rennke, the attention to reducing readmissions is an extension of her responsibility as a caregiver. “Our responsibility doesn’t end when the patient leaves the hospital,” she says. TH

Brendon Shank is SHM’s assistant vice president of communications.

Academic Hospitalist Academy

Tools to Succeed in Academic HM

Together with the Society of General Internal Medicine (SGIM) and the Association of Chiefs and Leaders of General Internal Medicine (ACGIM), SHM is presenting the third Academic Hospitalist Academy, October 25-28 at the Dolce Atlanta-Peachtree Resort.

The program is specially designed by expert faculty to address the unique needs of academic hospitalists, including such skills as effective teaching, scholarly research, career development, and promotion in academic settings.

Standard registration closes Sept. 15. To register, visit AcademicHospitalist.org. TH


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