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California Dreamin’


Project BOOST, SHM’s popular mentorship program designed to help hospitals reduce readmissions, is headed to the most populous state in the country. In a joint venture with the California HealthCare Foundation, Project BOOST (Better Outcomes for Older Adults through Safe Transitions) will launch a groundbreaking, two-year program in 20 hospitals in the Golden State.

The California HealthCare Founda-tion will cover almost half of the $28,000 in tuition costs for each hospital accepted into the collaborative program. Individual sites will be responsible for the other $14,500.

Project BOOST Growth click for large version

California HealthCare Foundation will cover almost half of the $28,000 in tuition costs for each hospital accepted into the Project BOOST collaborative program. Individual sites will cover the rest of the fee in SHM’s new tuition-based model.

In year one, hospitals will begin improving their discharge procedures using Project BOOST’s toolkit and one-on-one mentorships with leaders in the field. The second year of the project will focus on training additional mentors in California. The foundation has committed not only to improving outcomes in the first 20 sites, but also building a sustainable infrastructure that will allow gains to quickly spread throughout the state.

Recruiting for the California sites has just begun. Potential applicants can visit for more information.

“California is a microcosm for the challenges and opportunities for hospitalized care in our healthcare system,” says Janet Nagamine, RN, MD, SFHM, program leader for the California BOOST program and an SHM board member. “We are very excited to work with the California HealthCare Foundation, one of the state’s leaders in healthcare quality improvement. … Their support will help California’s hospitals and primary-care physicians [PCPs] safely transition patients from hospital to home during that vulnerable period.”

California HealthCare Foundation will cover almost half of the $28,000 in tuition costs for each hospital accepted into the Project BOOST collaborative program. Individual sites will cover the rest of the fee in SHM’s new tuition-based model. click for large version

California HealthCare Foundation will cover almost half of the $28,000 in tuition costs for each hospital accepted into the Project BOOST collaborative program. Individual sites will cover the rest of the fee in SHM’s new tuition-based model.

Project BOOST’s Continued Expansion

The California program will be SHM’s largest state-specific program to date, representing the fourth wave of BOOST’s continued expansion. With the support of the John A. Hartford Foundation, the program began with six pilot sites throughout the country in 2008. In 2009, Hartford funded 24 additional sites.

In January, SHM, the University of Michigan, and Blue Cross Blue Shield of Michigan announced the first state-specific Project BOOST program. The three organizations announced Michigan’s 14 participating sites in May.

Two other hospital sites began implementing Project BOOST on a tuition-based model in May.

Readmission Challenge

Most hospitalists are intimately familiar with the challenges involved with transitions of care. Research in the April 2009 New England Journal of Medicine by Stephen F. Jencks, MD, MPH, Mark V. Williams, MD, FHM, and Eric A. Coleman, MD, MPH, indicates that 1 in 5 hospitalized patients is readmitted to the hospital within a month of their discharge.1

Balancing the three-legged stool of communication between the hospitalist, PCP, and patient can be demanding. For the individual hospitalist or PCP, it requires intense attention to detail, strong communication skills, and patience. For hospitals, safe transitions require a systemic, team-based approach.

But the alternative—continued or increased readmissions after discharge—is even more taxing. The study found that unplanned readmissions cost Medicare $17.4 billion each year, making estimates of the total cost even higher.1

Looking beyond the costs directly associated with readmissions, the study’s authors see the issue as a potential vital sign that could assess overall healthcare quality. “Although the readmission rate is often presented as a measure of the performance of hospitals, it may also be a useful indicator of the performance of our healthcare system,” they write.

Piedmont Hospital:

Project BOOST unit vs. regular units

  • Lower length of stay, 4.09 days vs. 4.96 days, for patients under age 70, and 5.6 days as compared with 5.7 days for patients 70 and older.
  • Lower rates of mortality, 0.19% vs. 0.98%, among patients under age 70, and 0.83 vs. 3.48 for patients 70 and older.
  • Fewer 30-day readmissions, 8.5% vs. 25.5%, for those younger than 70, and 22.16% vs. 26.1% for older patients.

Source: SHM

The Approach: Gain Traction, Results

Rather than forcing a one-size-fits-all process on every hospital site, Project BOOST provides individual hospitals with the capacity and experience necessary to implement processes that best fit their unique situation.

Project BOOST sites participate in a two-pronged program consisting of a yearlong, one-on-one mentorship with the leaders in the field. It begins with an intensive, two-day conference and the Project BOOST toolkit.

The toolkit includes printed materials and a new DVD for use by hospitalists and other care providers to facilitate communication with patients and caregivers during discharge.

New case studies published by SHM document some of the program’s earliest successes.

At Piedmont Hospital, a 481-bed acute-care hospital near Atlanta, the full implementation of Project BOOST in one hospital unit has improved many of its “vital signs” in comparison with units that have not implemented BOOST, including decreased length of stay and lower 30-day readmissions (see “Piedmont Hospital: Project BOOST unit vs. regular hospital units,” p. 6).

For St. Mary’s Medical Center, a 582-bed community teaching hospital in St. Louis, hospitalists implementing Project BOOST made a major difference in just three months:

Not only did the Project BOOST unit nearly halve 30-day readmissions (7% from 12%), but the program also increased patient satisfaction, to 68% from 52%.

BOOSTing into the Future

Project BOOST benefits haven’t been limited to program sites and their patients. New innovations from the mentored implementation program have led to resources that all hospitals can use.

SHM recently introduced a new DVD and curriculum package that teaches nurses and discharge planners to use the “teachback” method to communicate with patients during the discharge process. It helps ensure that patients fully understand their care plans and post-discharge instructions.

The teachback package is available at the SHM online store (; it is $85 for SHM members and $125 for nonmembers.

SHM has also launched a BOOST data center and a BOOST community site. The data center enables sites to enter, track, and benchmark key outcomes, which can then be evaluated against comparison units at their own hospitals, BOOST averages, and subsets of hospitals with similar characteristics. The BOOST community site facilitates the sharing of ideas and documents between BOOST hospitals.

New funding approaches will help Project BOOST to continue to reach more hospitals. Since its inception, third parties have provided financial resources for the program.

Now, SHM is offering a tuition-based model, open to hospitals nationwide, which is set to begin this fall.

SHM is accepting applications at TH

Brendon Shank is a freelance writer based in Philadelphia.


  1. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Eng J Med. 2009:360:1418-1428.

“State of Hospital Medicine” Survey Coming in September

In September, hospitalists and hospital executives will be able to compare their practices to others across the country, thanks to a new report from SHM and the Medical Group Management Association (MGMA).

“This is the most comprehensive and largest survey of hospital medicine practices in the country,” says Leslie Flores, MHA, SHM’s senior advisor for practice management. “Our collaboration with MGMA allows us to expand the pool of people participating, and gives us even greater confidence in analysis and validity of the data.”

The new report will include compensation and productivity data for hospitalist practices, enabling HM group managers to better understand industry norms for practice sizes, turnover rates, and staffing models. It will provide national breakdowns for financial-support models of hospital medicine groups.

“This will give people a sense of the trends in the industry,” Flores says. “Not just how much they are getting paid, but how.”

The September report will serve as a supplement to MGMA’s comprehensive healthcare management survey report, which was published in June.

SHM members are eligible to receive a discount on the June report. To receive a discount code, e-mail—BS

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