Initial outcomes data for SHM's Project BOOST show a reduction in 30-day hospital readmission rates to 12.7% from 14.7% among a select group of 11 participating hospitals.
Results were reported online July 22 in the Journal of Hospital Medicine. “Participation in Project BOOST appeared to be associated with a decrease in readmission rates,” the study authors cautiously observe, although two accompanying editorials label the results as "limited" and "disappointing."
The research compares outcomes data for clinical acute-care units at 11 of 30 hospitals in the first two BOOST cohorts, started in 2008 and 2009, with clinically matched non-BOOST control units for all-patient, 30-day readmissions. Each BOOST site adopted two or more of the recommended interventions from the program’s toolkit for improving care transitions, with the support of an expert mentor. Reporting clinical outcomes was voluntary and uncompensated, and 19 of the hospitals in the initial cohorts did not share their data—cited as a serious limitation by authors of the editorials.
"You can look at our study on a couple of different levels," says lead author and BOOST lead analyst Luke Hansen, MD, MHS, of the division of hospital medicine at Northwestern University Feinberg School of Medicine in Chicago. "One is the sites that gave us data, and in that group there were statistically significant results. But I think the more important question is: Will that be enough? What is the magnitude of the effect, and is it enough to give hospitals the impetus they need to prevent avoidable readmissions?"
Project BOOST is one of SHM's national QI programs aimed at improving care transitions through such strategies as readmission risk assessments, medication reconciliation, patient coaching, and post-discharge follow-up calls. For hospitals and HM groups searching for solutions to the 30-day readmission dilemma—and thereby avoid Medicare reimbursement penalties, clear answers remain elusive.
"BOOST is one of a number of care transitions improvement methodologies that have been applied to the problem of readmissions, each of which has evidence to support their effectiveness in their initial settings, but has proven difficult to translate to other sites," JHM Editor-in-Chief Andrew D. Auerbach, MD, MPH, SFHM, a professor of medicine in residence at the University of California at San Francisco's division of hospital medicine, and co-authors note in an accompanying editorial.
Dr. Auerbach notes in his editorial that research problems limited the study's robustness but that "the authors provide the necessary start down the road towards a fuller understanding of real-world efforts to reduce readmissions."
In the other editorial, Ashish K. Jha, MD, MPH, of the Harvard School of Public Health, Health Policy, and Management suggests that readmissions ultimately may be the wrong target. A better goal, Dr. Jha says, is to improve transitions of care and demonstrate better processes in achieving those results—even though that might not significantly alter readmission rates. "We need to get clearer on what we’re trying to achieve," he adds.