1464. A 2-Year Analysis of 30-Day Hospital Readmissions and Cost Benefits of Septicemia Outpatient Treatment in a Physician Office Infusion Center (POIC)
Session: Poster Abstract Session: Antimicrobial Stewardship: Outpatient Parenteral Antibiotic Therapy
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • IDWeek 2015_Readmission Poster _#1464_Statner et al.pdf (984.9 kB)
  • Background: Septicemia constitutes a major cause for 30-day readmissions and is the most expensive condition treated in U.S. hospitals according to the Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project (HCUP). For patients (pts) with uncomplicated septicemia, outpatient parenteral antimicrobial therapy (OPAT) may offer benefit in preventing 30-day readmissions and reducing hospital costs.

    Methods: Medical records from pts treated at 12 Infectious Disease (ID) POICs over 2 years from 1/1/2013 to 12/31/2014 were retrospectively reviewed. Data include demographics, therapy characteristics, unplanned 30-day hospital admissions, causes and risk factors. Costs were measured by comparing 30-day readmission rates with average length of stay and inpatient costs derived from national HCUP data for septicemia. Statistical analysis was done by Fisher’s exact and ANOVA tests.

    Results: Among 525 septicemia pts, 71 (13.5%) were admitted to the hospital within 30 days of OPAT initiation including 35 for worsening infections, 17 for catheter-associated complications, 9 for new infections, 7 for adverse drug reactions, and 3 for reasons unrelated to diagnosis. Significant risk factors associated with readmissions were 3 or more comorbidities (OR 5.71, p<0.0001), 6-month prior hospitalization (OR 3.58, p<0.0001) and presence of malignancy (OR 1.96, p=0.01). Upon readmission, the average length of hospitalization post OPAT was 8.1 days compared to 11.1 days for national average. POIC-based OPAT of septicemia resulted in a 6.2% lower 30-day readmission rate than the national average of 19.7% (p=0.009). Based on HCUP data on length of stay and costs of the second admission of septicemia, the estimated hospital costs for the 71 OPAT readmissions would be $1.36 million. This compares to $2.72 million based on national average. The lower readmission rate combined with the shorter length of stay generated substantial OPAT cost savings of 50% (p<0.001).

    Conclusion: OPAT management and treatment of septicemia in an ID POIC resulted in a significantly lower readmission rate and shorter length of hospital stay following readmission. Costs were 50% lower than national averages with an overall savings of $1.36 million, significantly impacting overall healthcare expenditures.

    Barry Statner, MD, FRCPC, FIDSA1, Fernando S. Alvarado, MD, MPH & TM2, Brian Metzger, MD, MPH3, Richard M. Mandel, MD, FIDSA4, Jorge R. Bernett, MD5, H. Barry Baker, MD, FACP6, Alfred E. Bacon, III, MD7, Claudia P. Schroeder, PharmD, PhD8 and Lucinda J. Van Anglen, PharmD8, (1)Mazur, Statner, Dutta, Nathan, PC, Thousand Oaks, CA, (2)Infectious Disease Consultants, MD, PA, Altamonte Springs, FL, (3)Austin Infectious Disease Consultants, Austin, TX, (4)Southern Arizona Infectious Disease Specialists, PLC, Tucson, AZ, (5)Infectious Disease Doctors Medical Group, Walnut Creek, CA, (6)Infectious Disease Physicians, Miami, FL, (7)Infectious Disease Associates, PA, Newark, DE, (8)Healix Infusion Therapy, Inc., Sugar Land, TX

    Disclosures:

    B. Statner, None

    F. S. Alvarado, None

    B. Metzger, Cubist/Merck: Speaker's Bureau , Speaker honorarium
    Forest/Actavis: Speaker's Bureau , Speaker honorarium

    R. M. Mandel, None

    J. R. Bernett, None

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

    A. E. Bacon, III, None

    C. P. Schroeder, None

    L. J. Van Anglen, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.