title: Project BOOST implementation: lessons learned.
abstract: OBJECTIVE
  Enhancing care coordination and reducing hospital readmissions have been a focus of multiple quality improvement (QI) initiatives. Project BOOST (Better Outcomes by Optimizing Safe Transitions) aims to enhance the discharge transition from hospital to home. Previous research indicates that QI initiatives originating externally often face difficulties gaining momentum or effecting lasting change in a hospital. We performed a qualitative evaluation of Project BOOST implementation by examining the successes and failures experienced by six pilot sites. We also evaluated the unique physician mentoring component of this program. Finally, we examined the impact of intensification of the physician mentoring model on adoption of BOOST interventions in two later Illinois cohorts (27 hospitals).
  
  
  METHODS
  Qualitative analysis of six pilot hospitals used a process of methodological triangulation and analysis of the BOOST enrollment applications, the listserv, and content from telephone interviews. Evaluation of BOOST implementation at Illinois hospitals occurred via mid-year and year-end surveys.
  
  
  RESULTS
  The identified common barriers included inadequate understanding of the current discharge process, insufficient administrative support, lack of protected time or dedicated resources, and lack of frontline staff buy-in. Facilitators of implementation included the mentor, a small beginning, teamwork, and proactive engagement of the patient. Notably, hospitals viewed their mentors as essential facilitators of change. Sites consistently commented that the individualized mentoring was extremely helpful and provided significant accountability and stimulated creativity. In the Illinois cohorts, the improved mentoring model showed more complete implementation of BOOST interventions.
  
  
  CONCLUSIONS
  The implementation of Project BOOST was well received by hospitals, although sites faced substantial barriers consistent with other QI research reports. The unique mentorship element of Project BOOST proved extremely valuable in helping sites overcome their distinctive challenges and identify facilitators for success. The findings from this qualitative study should contribute to future BOOST implementation success and others' efforts to optimize hospital discharge transitions.
authors.affiliation: From the Department of Internal Medicine, the Center for Health Services Research, University of Kentucky, Lexington, Division of Hospital Medicine, the Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Society of Hospital Medicine, Philadelphia, Pennsylvania, Harvard University School of Medicine, Massachusetts General Hospital, Boston, Johns Hopkins University School of Medicine, Baltimore, Maryland, St Joseph Mercy Hospital, Ann Arbor, Michigan, Division of Hospital Medicine, Singapore Health Services, HealthcareLeadership College, Duke-National University of Singapore Graduate Medical School, Singapore, and Division of Health Care Policy and Research, University of Colorado, Denver.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Williams
authors.affiliation: From the Department of Internal Medicine, the Center for Health Services Research, University of Kentucky, Lexington, Division of Hospital Medicine, the Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Society of Hospital Medicine, Philadelphia, Pennsylvania, Harvard University School of Medicine, Massachusetts General Hospital, Boston, Johns Hopkins University School of Medicine, Baltimore, Maryland, St Joseph Mercy Hospital, Ann Arbor, Michigan, Division of Hospital Medicine, Singapore Health Services, HealthcareLeadership College, Duke-National University of Singapore Graduate Medical School, Singapore, and Division of Health Care Policy and Research, University of Colorado, Denver.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: From the Department of Internal Medicine, the Center for Health Services Research, University of Kentucky, Lexington, Division of Hospital Medicine, the Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Society of Hospital Medicine, Philadelphia, Pennsylvania, Harvard University School of Medicine, Massachusetts General Hospital, Boston, Johns Hopkins University School of Medicine, Baltimore, Maryland, St Joseph Mercy Hospital, Ann Arbor, Michigan, Division of Hospital Medicine, Singapore Health Services, HealthcareLeadership College, Duke-National University of Singapore Graduate Medical School, Singapore, and Division of Health Care Policy and Research, University of Colorado, Denver.
authors.forename: Luke O
authors.initials: LO
authors.lastname: Hansen
authors.affiliation: From the Department of Internal Medicine, the Center for Health Services Research, University of Kentucky, Lexington, Division of Hospital Medicine, the Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Society of Hospital Medicine, Philadelphia, Pennsylvania, Harvard University School of Medicine, Massachusetts General Hospital, Boston, Johns Hopkins University School of Medicine, Baltimore, Maryland, St Joseph Mercy Hospital, Ann Arbor, Michigan, Division of Hospital Medicine, Singapore Health Services, HealthcareLeadership College, Duke-National University of Singapore Graduate Medical School, Singapore, and Division of Health Care Policy and Research, University of Colorado, Denver.
authors.forename: Victoria
authors.initials: V
authors.lastname: Forth
authors.affiliation: From the Department of Internal Medicine, the Center for Health Services Research, University of Kentucky, Lexington, Division of Hospital Medicine, the Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Society of Hospital Medicine, Philadelphia, Pennsylvania, Harvard University School of Medicine, Massachusetts General Hospital, Boston, Johns Hopkins University School of Medicine, Baltimore, Maryland, St Joseph Mercy Hospital, Ann Arbor, Michigan, Division of Hospital Medicine, Singapore Health Services, HealthcareLeadership College, Duke-National University of Singapore Graduate Medical School, Singapore, and Division of Health Care Policy and Research, University of Colorado, Denver.
authors.forename: Tina
authors.initials: T
authors.lastname: Budnitz
authors.affiliation: From the Department of Internal Medicine, the Center for Health Services Research, University of Kentucky, Lexington, Division of Hospital Medicine, the Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Society of Hospital Medicine, Philadelphia, Pennsylvania, Harvard University School of Medicine, Massachusetts General Hospital, Boston, Johns Hopkins University School of Medicine, Baltimore, Maryland, St Joseph Mercy Hospital, Ann Arbor, Michigan, Division of Hospital Medicine, Singapore Health Services, HealthcareLeadership College, Duke-National University of Singapore Graduate Medical School, Singapore, and Division of Health Care Policy and Research, University of Colorado, Denver.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Greenwald
authors.affiliation: From the Department of Internal Medicine, the Center for Health Services Research, University of Kentucky, Lexington, Division of Hospital Medicine, the Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Society of Hospital Medicine, Philadelphia, Pennsylvania, Harvard University School of Medicine, Massachusetts General Hospital, Boston, Johns Hopkins University School of Medicine, Baltimore, Maryland, St Joseph Mercy Hospital, Ann Arbor, Michigan, Division of Hospital Medicine, Singapore Health Services, HealthcareLeadership College, Duke-National University of Singapore Graduate Medical School, Singapore, and Division of Health Care Policy and Research, University of Colorado, Denver.
authors.forename: Eric
authors.initials: E
authors.lastname: Howell
authors.affiliation: From the Department of Internal Medicine, the Center for Health Services Research, University of Kentucky, Lexington, Division of Hospital Medicine, the Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Society of Hospital Medicine, Philadelphia, Pennsylvania, Harvard University School of Medicine, Massachusetts General Hospital, Boston, Johns Hopkins University School of Medicine, Baltimore, Maryland, St Joseph Mercy Hospital, Ann Arbor, Michigan, Division of Hospital Medicine, Singapore Health Services, HealthcareLeadership College, Duke-National University of Singapore Graduate Medical School, Singapore, and Division of Health Care Policy and Research, University of Colorado, Denver.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Halasyamani
authors.affiliation: From the Department of Internal Medicine, the Center for Health Services Research, University of Kentucky, Lexington, Division of Hospital Medicine, the Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Society of Hospital Medicine, Philadelphia, Pennsylvania, Harvard University School of Medicine, Massachusetts General Hospital, Boston, Johns Hopkins University School of Medicine, Baltimore, Maryland, St Joseph Mercy Hospital, Ann Arbor, Michigan, Division of Hospital Medicine, Singapore Health Services, HealthcareLeadership College, Duke-National University of Singapore Graduate Medical School, Singapore, and Division of Health Care Policy and Research, University of Colorado, Denver.
authors.forename: Arpana
authors.initials: A
authors.lastname: Vidyarthi
authors.affiliation: From the Department of Internal Medicine, the Center for Health Services Research, University of Kentucky, Lexington, Division of Hospital Medicine, the Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Society of Hospital Medicine, Philadelphia, Pennsylvania, Harvard University School of Medicine, Massachusetts General Hospital, Boston, Johns Hopkins University School of Medicine, Baltimore, Maryland, St Joseph Mercy Hospital, Ann Arbor, Michigan, Division of Hospital Medicine, Singapore Health Services, HealthcareLeadership College, Duke-National University of Singapore Graduate Medical School, Singapore, and Division of Health Care Policy and Research, University of Colorado, Denver.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Coleman
mesh_terms: D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007087:Illinois; D008611:Mentors; D010351:Patient Discharge / Q000592:standards*; D010865:Pilot Projects; D016730:Program Development; D015397:Program Evaluation; D036301:Qualitative Research; D058996:Quality Improvement; D011795:Surveys and Questionnaires