Reducing Avoidable Return Trips to the Hospital

"I am truly grateful to AHRQ for our collaboration that led to RED, the toolkit, and dissemination of these ideas to hospitals throughout the U.S. and the world. It’s something that should be provided to all patients leaving the hospital."

Brian Jack, M.D., has spent more than a decade pursuing a quest to reduce the risk of patients being unnecessarily readmitted to the hospital, supported much of the time by AHRQ funding to advance and apply knowledge in this critical area.

A professor and family physician who chairs the Department of Family Medicine at Boston University School of Medicine, Dr. Jack initiated this research in 2003 with a protocol addressing the common factors among patients who were readmitted to the hospital within 30 days of discharge. The protocol, funded by AHRQ and known as RED (short for the Re-Engineered Discharge), includes specific strategies that, when used together, promote safer patient care and reduce avoidable hospital readmissions. They include making follow-up appointments with patients’ primary care physician, identifying the correct medications that patients should take, educating patients about their diagnosis, and assessing patients’ understanding of their care.

With additional AHRQ grant funding in 2005, Dr. Jack and colleagues tested the RED protocol through a randomized controlled trial at Boston Medical Center, an urban safety-net hospital where he practices. The findings, published in a 2009 issue of the Annals of Internal Medicine, confirmed Dr. Jack’s theory: Patients  whose care incorporated the RED protocol had almost one-third fewer return trips to the hospital (both readmissions and emergency department visits) within 30 days and an average of $400 lower costs.  

To help other facilities apply this knowledge, AHRQ contracted with Dr. Jack in 2013 to expand his protocol into an implementation-ready toolkit. The toolkit includes resources to help health providers apply RED as well as address language barriers and disparities in health care communication and trust.  Trainings to implement the RED toolkit have taken place in scores of hospitals across the U.S. and abroad. A patient education tool, Taking Care of Myself: A Guide for When I Leave the Hospital, was also created in English and Spanish.

"I am truly grateful to AHRQ for our collaboration that led to RED, the toolkit, and dissemination of these ideas to hospitals throughout the U.S. and the world," Dr. Jack said. "Better preparing patients to care for themselves after hospital discharge and their family caregivers to assist them is a common-sense way that we can both improve health and lower health care costs.  It’s something that should be provided to all patients leaving the hospital."

Dr. Jack, who received AHRQ’s Patient Safety Investigator Award in 2007, has also received AHRQ grant funds to help improve patients’ medication use after a hospital visit.  In this project, Dr. Jack developed a virtual patient avatar to reinforce RED’s after-care summary for patients. The avatar, named Louise, describes how to take medications and relays concerns patients have, such as side effects, to nurses for next-day follow-up.    

Dr. Jack continues to leverage what he has learned about identifying and overcoming factors that affect hospital readmissions, expanding his research to address other conditions. With current AHRQ grant funding, he is now advancing his work on RED to see if the protocol is effective at lowering hospital readmission rates for patients with depression. 

Principal Investigator: Brian Jack, M.D., Professor and Chair, Department of Family Medicine
Institution: Boston University School of Medicine
Grantee Since: 2003
Type of Grant: Various

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