Mentoring project reduces 30-day rehospitalizations by 13.6%

Participating in a Society of Hospital Medicine mentoring program appears to help hospitals reduce 30-day readmissions, according to a study published today in the Journal of Hospital Medicine.

Hospitals participating in Project BOOST (Better Outcomes by Optimizing Safe Transitions) reduced their average 30-day rehospitalization rate by 13.6 percent, the study found, falling from 14.7 percent to 12.7 percent after one year in the program. Comparable hospitals that did not implement BOOST saw a slight increase in readmissions, from 14 percent to 14.1 percent.

Project BOOST provides tools to identify patients at high risk for readmissions, effectively communicate discharge plans, and follow up with phone calls and timely doctors' appointments. Physician mentors are a key component, reported Medical News Today.

BOOST principal investigator Mark V. Williams, M.D., of the Northwestern University Feinberg School of Medicine said that based on the findings, the program has been modified to "increase the intensity of the BOOST intervention."

The scope of the study was limited, with only 11 of 30 Project BOOST hospitals participating at the time providing hospital unit-specific data, Medical News Today noted.

In an accompanying editorial, Ashish Jha, M.D., of the Harvard School of Public Health noted disappointment with the findings based on low participation.

"(T)he fact that 19 of the 30 hospitals that received substantial training and assistance through the BOOST program chose not to report their data is unconscionable," Jha wrote. "The decision by those 19 hospitals to withhold data makes the results nearly uninterpretable and jeopardizes the hard work that so many others have engaged in."

A better question for future study might be whether BOOST improves patient care following discharge, Jha wrote.

In another accompanying editorial, Andrew Auerbach, M.D., of the University of California San Francisco School of Medicine, raised similar concerns about the findings and questioned whether the initial version of BOOST produced broad reductions in readmission rates. The program's "flexibility is both a great source of strength and a clear challenge to rigorous evaluation," he wrote.

"Having said this, the authors provide the necessary start down the road toward a fuller understanding of real-world efforts to reduce readmissions," he wrote.

The BOOST findings echo those of another study looking at how a collaborative between three nonprofit hospitals in the Bronx, N.Y., involving personal contact with patients before and after discharge reduced rehospitalizations.

Of 500 patients receiving two or more personal contacts, 17.6 were readmitted within 60 days, compared with 26.3 percent of 190 patients receiving standard care. A follow-up physician visit within two weeks of discharge also helped reduce readmissions, the research found.

For more:
-here's the study abstract
-read the Medical News Today article
-here's Jha's commentary
-here's Auerbach's commentary
 
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