1090. Early ID Outpatient Follow-up of OPAT Patients Reduces 30-day Readmission
Session: Poster Abstract Session: Clinical Practice Issues
Friday, October 6, 2017
Room: Poster Hall CD
Background: Although weekly outpatient follow-up for patients discharged on outpatient parenteral antimicrobial therapy (OPAT) has been recommended, few practitioners follow this recommendation. No studies have examined the relationship between outpatient follow-up and patient outcomes for this population. We examined the association between outpatient ID follow-up and the risk for 30-day readmission for patients discharged on OPAT.

Methods: We conducted a retrospective cohort study using EMR data comprising 1102 OPAT patients treated between January 2012 and December 2014 at a major tertiary care medical center. We sought to determine whether ID outpatient follow-up was associated with a lower risk of 30-day readmission, after adjusting for patient demographics, infection diagnosis, outpatient antibiotics, and comorbidities (mainly diabetes mellitus, renal failure and immunosuppression).

Results:  Of 1102 cases, 201 of 1102 (18%, 95 females, 106 males) were readmitted within 30 days, of whom 133 (66%) were re-admitted in the first 2 weeks post discharge. 837 (76%) were seen in ID outpatient follow-up within 30 days of discharge, of whom 396 (47%) were seen in first 2 weeks. By univariate analysis OPAT patients seen in ID outpatient follow-up within 2 weeks of discharge were less likely to get readmitted within 30 days of hospital discharge (OR: 0.6, CI: 0.4-0.9, p<0.02). Patients with immunosuppression (OR: 1.9, 95% CI: 1.3-2.7, p<0.0001) or discharged on 3 or more antimicrobials (OR: 2.1, 95% CI:1.4-3.2, p<0.0001) were more likely to have 30-day readmission. By multivariate analysis patients seen in outpatient ID follow-up within 2 weeks (OR: 0.6, CI: 0.4-0.9, p<0.006) or those receiving ceftriaxone alone (OR: 0.6, CI: 0.3-0.9, p<0.015) were less likely to have 30-day readmission. Patients who were immunosuppressed (OR: 1.9, CI: 1.3-3.0, p<0.003) or those discharged on 3 or more antimicrobials (OR: 2.1, CI: 1.4-3.2, p<0.001) were more likely to have 30-day readmission.

Conclusion: Infectious disease outpatient follow-up within 2 weeks for patients discharged on OPAT reduces all-cause 30-day readmission. Early outpatient follow-up is especially important for patients who are immunosuppressed and those receiving multiple antibiotics.

Ena Saini, MD, Mohammad Ali, MD, MPH, Ping Du, MD, PhD, Tonya Crook, MD and John Zurlo, MD, Infectious Diseases, Penn State Milton S Hershey Medical Center, Hershey, PA

Disclosures:

E. Saini, None

M. Ali, None

P. Du, None

T. Crook, None

J. Zurlo, None

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