Reducing Hospital Readmissions: Lessons from Project BOOST

By Kindred Healthcare
 Mark Williams, MD Mark Williams, MD

Mark V. Williams, MD

Professor and Chief of the Division of Hospital Medicine at Northwestern University Feinberg School of Medicine

Details and lessons learned from Project BOOST, a Society of Hospital Medicine-sponsored program that seeks to improve the care of patients as they transition from a hospital to another facility or to home, were shared with Clinical Impact Symposium participants by project leader Mark V. Williams, MD, Professor and Chief of the Division of Hospital Medicine at Northwestern University Feinberg School of Medicine in Chicago.

Williams was an investigator on a 2011 New England Journal of Medicine study looking at rehospitalizations among patients in the Medicare fee-for-service program. The study found:

  • One in five Medicare patients was rehospitalized within 30 days.
  • Half never saw an outpatient doctor before being bounced back to the hospital.
  • Seventy percent of patients readmitted after surgery were not readmitted for surgical complications, but for simultaneous but independent diseases or conditions, or comorbidities.

The study also showed that the readmissions cost to Medicare in 2004 was $17.4 billion. This research, other similar data, and changes in the healthcare policy landscape in the United States, spurred the development and growth of the Project BOOST program.

“The real game-changer was the Patient Protection and Affordable Care Act,” said Williams. With the implementation of this act, the government has announced that penalties will be imposed on hospitals that have higher-than-expected readmissions rates.

“CMS is no longer paying just because a hospital delivered care,” Williams said. Quality, not quantity, will be rewarded.

“CMS is no longer paying just because a hospital delivered care, quality, not quantity, will be rewarded." -Mark Williams, MD

Project BOOST, which has been implemented in 130 hospital sites across the country over the past five years, is designed to meet the challenges posed both by the new policy and the readmissions research.

Project BOOST member organizations receive a toolkit that includes project management tools, clinical tools, and the “secret sauce” of Project Boost: mentored implementation.

“We bring someone in to figure how to integrate these tools into the workflow, and hold their feet to the fire when necessary,” he said.

Checklists are often helpful; four drugs are responsible for two thirds of emergency hospitalizations for adverse drug events in older Americans, for example. A checklist listing these drugs for providers can remind them to integrate this concern into discharge planning if necessary.

Mindfulness of the patient’s perspective in providing discharge instructions is imperative, said Williams. “Patients want to know what they need to know,” he said, discounting the need for lengthy information about their condition in technical terms.

Teachback is another important tool; the program encourages discharging clinicians to keep explanations in lay language and then ask patients to explain or show what they have just been told, to ensure they understand it correctly.

Williams used this video to emphasize the importance of Teachback:

Mark Williams, MD