Collaborative Looks to Reduce Hospital Readmissions

Three groups are coming together to form a new statewide initiative to assist in reducing avoidable readmission rates and emergency room visits in Michigan.

The new program, created by The Society of Hospital Medicine (SHM), Blue Cross Blue Shield of Michigan, and the University of Michigan, will soon select 15 hospital and physician care sites in Michigan to participate, with training beginning in May.

The program is based on SHM's Project BOOST (Better Outcomes for Older Adults through Safer Transitions) model, and will be managed by the University of Michigan in collaboration with Blue Cross Blue Shield of Michigan. The Michigan Blues currently provide and administer health benefits to 4.7 million Michigan residents.

Project BOOST, which is just over a year old, is working with hospitals to reduce readmission rates by providing them with proven resources and mentoring to optimize the discharge transition process, enhance patient and family education practices, and improve the flow of information between inpatient and outpatient providers. Project BOOST was developed through a grant from The John A. Hartford Foundation.

Each improvement team will be assigned a mentor to coach them through the process of planning, implementing, and evaluating Project BOOST at their site, according to Mark Williams, MD, who is the principal investigator for Project BOOST. Program participants will receive face to face training and monthly coaching sessions with their mentors—what he calls the "secret sauce" of the program. The sites also participate in an online peer learning and collaboration network.

"BOOST is ongoing at over 30 hospitals right now. What we plan to do with this initiative is bring 15 more online with efforts focused on Michigan hospitals," says Scott Flanders, MD, FHM, director of hospital medicine at the University of Michigan and president of the Society of Hospital Medicine.

Examining readmissions and care transitions have been "in the spotlight recently and a major potential area for quality improvement in how we do the care discharge from hospitals," Flanders says. "I think Blue Cross Blue Shield of Michigan recognized that this was a great target area. They were also very interested in partnering with hospitalists [since] hospitalists increasingly are involved in the care of a larger percentage of hospitalized general medical patients across the country, and certainly in the state of Michigan."

Williams added that Project BOOST initially rolled it out in six pilots in fall 2008.Hospitals enrolled in the program can now be found throughout the country.

Some of the early results from the program are:

• At Piedmont Hospital near Atlanta, the rate of unplanned readmissions among patients under the age of 70 participating in BOOST is 8.5%, compared to 25.5% among nonparticipants. The rate among BOOST participants over the age of 70 was 22% versus 26% of nonparticipants at Piedmont Hospital.
• Unplanned 30 day readmissions dropped from 12% to 7% within three months at SSM St. Mary's Medical Center in St. Louis after the facility implemented BOOST at its 33 bed hospitalist unit.