Project BOOST Implementation: Lessons Learned
Project BOOST Implementation: Lessons Learned
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DOI：
10.14423/smj.0000000000000140
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发表时间：
2014-07-01
影响因子：
1.1
通讯作者：
Coleman, Eric A.
中科院分区：
文献类型：
--
作者：
Williams, Mark V.;Li, Jing;Coleman, Eric A.
目的：加强护理协调和减少再入院一直是多个质量改进（QI）倡议的重点。BOOST项目（通过优化安全过渡获得更好的结果）旨在加强从医院到家庭的出院过渡。以前的研究表明，QI倡议起源于外部往往面临困难，获得动力或影响持久的变化在医院。我们通过检查六个试点地点的成功和失败经验，对BOOST项目的实施进行了定性评估。我们还评估了该计划独特的医生指导部分。最后，我们研究了强化的医生指导模式的影响，通过BOOST干预措施在两个后来的Illinois队列（27 hospitals）.Methods：定性分析的六家试点医院使用的方法三角测量和分析的过程中的BOOST招生申请，listserv，和内容的电话采访。BOOST的实施在伊利诺伊州的医院发生通过年中和年终surveys.Results的评价：确定的共同障碍，包括对目前的出院过程的理解不足，行政支持不足，缺乏保护的时间或专用资源，以及缺乏一线工作人员买进。实施的促进者包括导师，一个小的开始，团队合作，和病人的积极参与。值得注意的是，医院将他们的导师视为变革的重要推动者。各研究中心一致认为，个性化指导非常有帮助，提供了重要的问责制并激发了创造力。在伊利诺伊州的队列，改进的指导模式显示更完整的实施BOOST interventions.Conclusions：项目BOOST的实施受到医院的好评，虽然网站面临着与其他QI研究报告一致的重大障碍。BOOST项目独特的导师制元素在帮助研究中心克服其独特的挑战和确定成功的促进者方面证明是非常有价值的。这项定性研究的结果应有助于未来BOOST实施的成功和其他人的努力，以优化出院过渡。
Objectives: 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.