1465. Impact of an Infectious Diseases Transitions Service on Outcomes in Patients Discharged on Parenteral Antibiotics Requiring Therapeutic Drug Monitoring
Session: Poster Abstract Session: Antimicrobial Stewardship: Outpatient Parenteral Antibiotic Therapy
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • Jillian Dougherty, PharmD. OPAT Poster IDWeek 2015..pdf (216.9 kB)
  • Background: An increasing number of patients are being discharged on outpatient parenteral antimicrobial therapy (OPAT) resulting in shorter hospital lengths of stay and reduced hospital costs.  There is little information on the practice of monitoring patients receiving intravenous (IV) antibiotics that require therapeutic drug monitoring in the outpatient setting.  The purpose of the current study is to determine the impact of a pharmacist-managed infectious diseases transition service (IDTS) on hospital readmissions in patients discharged on IV vancomycin and aminoglycosides.   

    Methods: This is a retrospective, controlled, quasi-experimental study that was approved by the Institutional Review Board.  Patients discharged on IV vancomycin or an aminoglycoside from May 11, 2009 through July 11, 2014 were included and divided into an intervention or control arm.  Both groups spanned the entire study duration to test the impact of IDTS implementation that occurred on December 12, 2011.  Intervention arm patients received an infectious diseases (ID) consult and had follow-up in the ID clinic as an outpatient, whereas control arm patients did not receive an ID consult nor had ID follow-up.  Data collection was obtained using an IDTS patient database and electronic medical records.  The primary endpoint of hospital readmissions at day 30 post-discharge was evaluated using a differences-in-differences approach.  Secondary outcomes include hospital readmissions at day 7 and 60, ED visits, OPAT-related readmissions and ED visits, mortality, and clinical- and process-related outcomes.

    Results:  A total of 1403 patients were evaluated, with 827 patients in the intervention arm and 576 patients in the control arm.  For the intervention arm, the 30-day readmission rate was 22.4% for the pre-IDTS group and 16.8% for the post-IDTS group (P-value = 0.110).  For the control arm, the 30-day readmission rate was 26.8% for the pre-group and 26.1% for the post-group.  The difference-in-differences value between the intervention and control arms was 4.9 (P-value = 0.340).

    Conclusion: Although the results were not statistically significant, there is a lower rate of 30-day hospital readmissions in the post-IDTS intervention group.

    Julianne Gardner, PharmD1, Jillian Dougherty, PharmD1, Daniel Timko, PharmD, BCPS, AQID1, Shawn Binkley, BS, PharmD1, Steven Morgan, PharmD, BCPS, AQID1, Valerie Cluzet, MD2, David Pegues, MD, FIDSA, FSHEA3, Keith Hamilton, MD4 and the CDC Prevention Epicenters Program, (1)Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA, (2)Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, PA, (3)Healthcare Epidemiology, Infection Prevention and Control, Hospital of the University of Pennsylvania, Philadelphia, PA, (4)Medicine - Infectious Diseases, University of Pennsylvania School of Medicine/Hospital of the University of Pennsylvania, Philadelphia, PA

    Disclosures:

    J. Gardner, None

    J. Dougherty, None

    D. Timko, None

    S. Binkley, None

    S. Morgan, None

    V. Cluzet, None

    D. Pegues, None

    K. Hamilton, None

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