Program Schedule

763
Low Hospital Admission Rates Following Physician Office Infusion Center (POIC)-Based Outpatient Treatment with Intravenous Antibiotics (IVABs)

Session: Poster Abstract Session: Clinical Practice Issues
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • IDWeek 2014_Alvarado et al_763_Readmission Poster.pdf (437.6 kB)
  • Background: Current Centers for Medicare & Medicaid Services 30-day hospital (hosp) readmissions for all medical discharges are 16.1%, with many of these preventable. Outpatient antibiotic therapy (OPAT) has proven beneficial for patient (pt) safety and quality of care, however, little is known about hosp admissions following OPAT in a POIC. A recent study indicated a readmission rate of 26% for all OPAT settings. Our study investigates 30-day unplanned hosp admissions of pts treated with IVABs only through an Infectious Disease (ID) POIC.

    Methods: 600 pts were retrospectively evaluated from centralized databases; 60 random pts from each of 10 POICs from Jan 01 to Jun 30, 2013. Pt demographics, diagnosis, comorbidities, drug therapy, emergency department (ED) visits and hosp admissions within 30 days of OPAT initiation. Comparison of unplanned admissions was done by Fisher’s exact test. Risk factors for hosp admissions were assessed using odds ratios (OR).

    Results: Altogether, 41 of 600 pts (6.8%) had unplanned admissions to the hosp within 30 days of receiving OPAT. Readmissions for previously hospitalized occurred in 32/404 pts (8%) and 9/196 pts (5%) were admitted following POIC-initiated OPAT (p=0.39). For all admissions, 24 (59%) were for worsening infection, 3 (7%) for device-related issues, 5 (12%) for new or unrelated infections and 9 (22%) for reasons unrelated to infection. ED visits were reported for 38/600 pts (6.3%) with 40% resulting in hospitalization. Frequent diagnoses reported in pts admitted were bacteremia (27%), intra-abdominal (20%) and skin and skin structure infections (15%) with a mean length of treatment of 12, 14, and 11 days, respectively. Risk factors analyzed for hosp admissions were co-morbidities ≥ 3 (26/41pts; OR 9.1), prior 6 month hosp admissions (23/41; OR 6.7), age ≥ 60 yrs (22/41 pts; OR 6.08), obesity (12/41pts; OR 2.2), bacteremia (11/41 pts; OR 1.9), malignancy (10/41pts; OR 1.7), and diabetes (10/41pts; OR 1.7).  

    Conclusion: POIC-based OPAT following hosp discharge resulted in lower hosp readmission rates than indicated in current data. POIC-based OPAT without previous hospitalization resulted in even fewer hosp admissions. OPAT by an ID physician in an office-based setting provides highly effective, high quality therapy, leading to a reduction in costly hosp admissions and readmissions.

    Fernando S. Alvarado, MD, MPH & TM1, Brian Metzger, MD, MPH2, Richard M. Mandel, MD, FIDSA3,4, Richard C. Prokesch, MD, FACP, FIDSA5, Robin H. Dretler, MD, FIDSA6, H. Barry Baker, MD, FACP7, Claudia P. Schroeder, PharmD, Ph.D8 and Lucinda J. Van Anglen, PharmD8, (1)Infectious Disease Consultants, MD, PA, Altamonte Springs, FL, (2)Austin Infectious Disease Consultants, Austin, TX, (3)Southern Arizona Infectious Disease Specialists, PLC, Tucson, AZ, (4)University of Arizona College of Medicine, Tucson, AZ, (5)Infectious Diseases Associates, Riverdale, GA, (6)Infectious Disease Specialists of Atlanta, P.C., Decatur, GA, (7)Infectious Disease Physicians, Miami, FL, (8)Healix Infusion Therapy, Inc., Sugar Land, TX

    Disclosures:

    F. S. Alvarado, Pfizer: Speaker's Bureau, Speaker honorarium

    B. Metzger, None

    R. M. Mandel, None

    R. C. Prokesch, None

    R. H. Dretler, None

    H. B. Baker, Cubist: Speaker's Bureau, Speaker honorarium

    C. P. Schroeder, None

    L. J. Van Anglen, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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