BOOST also offers a comprehensive mentoring program. The yearlong assistance includes a daylong training session for the improvement team, regular calls between the participating hospital’s leader and project mentor, and individualized support using the BOOST toolkit. The intervention provides evidence and expert-based interventions for risk assessment, discharge education utilizing teach-back processes, and guidance for determining the need, timing and content of follow-up communications with receiving MDs and patients and families.
The program is offered at no charge to institutions because of the Hartford grant. Applications for the April 2009 training group of 24 sites will be accepted beginning in October.
The 7 P’s
A critical element in the intervention is a risk-assessment transition evaluation form known as a “7P Risk Scale.” The P’s stand for:
- Prior non-elective hospitalization in the past six months;
- Problem medications, including anticoagulants, insulin, aspirin plus clopidogrel (an anti-platelet agent) combination therapy, digoxin (digitalis), and narcotics;
- Punk (a positive depression screen or depression diagnosis);
- Principal diagnosis of cancer, stroke, diabetes mellitus, chronic obstructive pulmonary disease, or heart failure;
- Polypharmacy (taking five or more medications routinely);
- Poor health literacy; and
- Patient support (absence of a caregiver to assist with the discharge or home care).
This 7P risk assessment is completed when a patient is admitted to the hospital. It highlights the necessity of early identification of patients at risk of premature re-hospitalization or other adverse events during the post-discharge period.
The scale may be used throughout the hospitalization to improve risk identification and reduce adverse events. Linked to the assessment is a risk-specific intervention checklist that guides users in how to address the identified risk factor in a patient-centered fashion. The risk-specific checklist is coupled with a universal one with elements that apply more broadly to hospitalized patients. TH