1634. A 9-Point Risk Assessment for Patients Who Inject Drugs Requiring Intravenous Antibiotics May Allow Health Systems to Focus Inpatient Resources on Those at Greatest Risk of Ongoing Drug Use
Session: Oral Abstract Session: Changing Clinical Practice for Changing Times
Friday, October 5, 2018: 2:00 PM
Room: S 157
Background: We implemented an Intravenous Antibiotics and Addiction Team (IVAT) intervention to identify hospitalized persons with a history of injection drug use (IDU) that are safe for discharge with IV antibiotics based on a 9 point risk assessment. IVAT has been shown to reduce average length of stay (ALOS) without increasing readmissions. We analyzed the cost savings of the IVAT to the health system.

Methods: PWID at the University of Alabama at Birmingham (UAB) hospital with indications for prolonged IV antibiotics received IVAT to determine risk of continued IDU. “Low risk” patients were discharged for outpatient antibiotics and addiction care; others continued inpatient antibiotics, group therapy, opioid agonist therapy (if applicable), and weekly assessment for discharge readiness. Cost of care was defined by direct costs and was obtained by querying financial accounts.

Results: A total of 37 pre-IVAT and 111 post-IVAT admissions (including 25 “low risk”) met study criteria. IVAT reduced ALOS by 20 days. Total direct costs per admission in the post-IVAT period were 33% lower: $26,014 versus $38,716 (Table 1). Because ALOS at UAB for all patients is 6.58 days, a 20 day ALOS reduction following IVAT creates capacity for an additional 333 patients (n= 20/6.58 x 111).

Conclusion: IVAT for PWID allows health systems to focus inpatient resources on those at greatest risk of ongoing IVDU, creates additional inpatient capacity, and may cut hospital direct costs by one third.

Table 1. Hospital Utilization before and after IVAT Implementation

Inpatient Costs

Pre-Intervention

1/2015-2/2016

Post-Intervention

10/2016-1/2018

Number of admissions

N=37

N=111

Risk Group

· Low

· Medium

· High

N/A

25 (27%)

56 (61%)

11 (12%)

Total Direct Costs

$1,432,497

$2,887,515

Average LOS

42

22

Uninsured Patients

20 (54%)

53 (48%)

Medicaid Beneficiaries

13 (35%)

31 (28%)

Medicare Beneficiaries

3 (8%)

9 (8%)

Commercially insured Patients

1 (3%)

18 (16%)

Inpatient Costs per Admission

Total Direct Costs

$38,716

$26,014

Direct Costs/day

$922

$1,182

Inpatient Costs per Admission categorized by service

Nursing Costs

$16,305

$9,139

Pharmacy Costs

$8,829

$5,720

Surgery Costs

$4,986

$3,474

ICU Costs

$2,568

$2,081

Ellen Eaton, MD1, Ronald Mathews, Assistant Professor2, Peter S. Lane, DO3, Cayce S. Paddock, MD4, J. Martin Rodriguez, MD5, Benjamin B. Taylor, MD3, Michael Saag, MD, FIDSA6, Meredith Kilgore, PhD2 and Rachael Lee, MD2, (1)Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL, (2)University of Alabama, Birmingham, Birmingham, AL, (3)University of Alabama at Birmingham, Birmingham, AL, (4)University of Alabama Birmingham, Birmingham, AL, (5)Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, (6)Medicine, University of Alabama at Birmingham, Birmingham, AL

Disclosures:

E. Eaton, None

R. Mathews, None

P. S. Lane, None

C. S. Paddock, None

J. M. Rodriguez, finch: Research Contractor , Research support . seres: Research Contractor , Research support .

B. B. Taylor, None

M. Saag, None

M. Kilgore, None

R. Lee, None

Previous Abstract | Next Abstract >>

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.