Project BOOST: Effectiveness of a multihospital effort to reduce rehospitalization

Authors


Address for correspondence and reprint requests: Mark V. Williams, MD, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario Street, Suite 700, Chicago, IL 60611; Telephone: 585–922-4331; Fax: 585–922-5168; E-mail: markwill@nmh.org

Abstract

BACKGROUND

Rehospitalization is a prominent target for healthcare quality improvement and performance-based reimbursement. The generalizability of existing evidence on best practices is unknown.

OBJECTIVE

To determine the effect of Project BOOST (Better Outcomes for Older adults through Safe Transitions) on rehospitalization rates and length of stay.

DESIGN

Semicontrolled pre–post study.

SETTING/PARTICIPANTS

Volunteer sample of 11 hospitals varying in geography, size, and academic affiliation.

INTERVENTION

Hospitals implemented Project BOOST-recommended tools supported by an external quality improvement physician mentor.

METHODS

Pre–post changes in readmission rates and length of stay within BOOST units, and between BOOST units and site-designated control units.

RESULTS

The average rate of 30-day rehospitalization in BOOST units was 14.7% prior to implementation and 12.7% 12 months later (P = 0.010), reflecting an absolute reduction of 2% and a relative reduction of 13.6%. Rehospitalization rates for matched control units were 14.0% in the preintervention period and 14.1% in the postintervention period (P = 0.831). The mean absolute reduction in readmission rates in BOOST units compared to control units was 2.0% (P = 0.054 for signed rank test comparing differences in readmission rate reduction in BOOST units compared to site-matched control units).

CONCLUSIONS

Participation in Project BOOST appeared to be associated with a decrease in readmission rates. Journal of Hospital Medicine 2013;8:421–427. © 2013 Society of Hospital Medicine

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