1329. A Transitional Care Model of Outpatient Parenteral Antibiotic Therapy Reduces 30-day Readmission Rates
Session: Poster Abstract Session: Clinical Practice Issues
Friday, October 28, 2016
Room: Poster Hall
Background:

Outpatient parenteral antibiotic therapy (OPAT) is a safe and effective alternative to prolonged hospitalization for antibiotic therapy. However, OPAT patients are often complex and at risk for complications and readmission. Transitional care models (TCM) have been associated with improved outcomes. We assessed readmission, Emergency Department (ED) visit, and adverse event rates in patients enrolled in a TCM-OPAT program at the Montefiore Medical Center in Bronx, NY.

Methods:

Patients requiring intravenous (IV) antibiotics post discharge were enrolled. An inpatient transition note documented details of the hospitalization, treatment plan, and outpatient ID follow up. A nurse contacted patients one week after discharge. Patients were seen regularly by an ID physician who maintained contact with the outpatient care team. Outcomes were compared to a historic control cohort of patients discharged on IV antibiotics.

Results:

146 patients were enrolled in the TCM-OPAT program between July 2015 and February 2016. ED visits within 30 days of discharge were not significantly different in the TCM-OPAT and control groups (table 1). Fewer ED visits resulted in hospital admission in the TCM-OPAT group (47.6% vs. 67.6%, p<0.05), and 30-day readmission rate was lower in the TCM-OPAT group (table 1). 26.5% of patients in the TCM-OPAT group had adverse events within 60 days of discharge. Mortality was low in both groups. Length of stay was similar (12.13 vs. 11.3 days, p>0.05).

Conclusion:

Patients enrolled in our TCM-OPAT program had lower 30-day re-admission rates compared to our historic cohort, despite similar ED utilization, and an adverse event rate of 26.5%, consistent with prior published OPAT studies. We hypothesize that the presence of an outpatient clinical support system and early detection of adverse events could allow for safe ED discharge in OPAT patients, thus avoiding hospital readmission.

Table 1. Primary and secondary outcomes

TCM-OPAT (n=146)

Control (n=430)

p-value

30-day ED Visit

41 (28.1%)

131 (30.5%)

p=0.586719

30-day Readmission

21 (14.4%)

110 (25.6%)

p=0.005288

30-day All-Cause Mortality

1 (0.7%)

9 (2.1%)

p=0.4646

Elisabeth Zukowski, MD1, Priya Nori, MD2 and Theresa Madaline, MD2, (1)Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center, Bronx, NY, (2)Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY

Disclosures:

E. Zukowski, None

P. Nori, None

T. Madaline, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.