1932. Healthcare Utilization in Older versus Younger Adults on Outpatient Parenteral Antimicrobial Therapy According to Discharge Location
Session: Poster Abstract Session: Clinical Practice Issues: OPAT
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • IDWeek OPAT Poster 9.26.18 Final.pdf (1.2 MB)
  • Background: Older adults may require increased supervision during outpatient parenteral antimicrobial therapy (OPAT), particularly those discharged home vs a skilled nursing facility (SNF).  

    Methods: We performed a quality improvement project of all patients initiated on OPAT during admission to Yale New Haven Hospital between 10/1/2016 and 9/30/2017.  Descriptive data were collected.  Healthcare utilization according to discharge location was assessed in older (age ≥ 65 years) vs younger (age < 65 years) adults in the 6 months following OPAT initiation.  Differences between groups were assessed using x2 and t tests. 

    Results: We identified 450 patients initiated on OPAT.  Table 1 shows descriptive characteristics.  Median OPAT duration was 31 days (range 1-155) for older adults and 34 days (range 1-183) for younger adults. Discharge to skilled nursing facility (SNF) was more likely in older (71%, N=139/197) vs younger (42%, N=105/253) adults (p<.0001) following OPAT initiation. However, there was no difference in healthcare utilization according to discharge location (Table 2).  Healthcare utilization was also similar between older and younger adults across antimicrobials (Figure 1).

    Conclusion: Regardless of discharge home vs SNF, there was no difference in healthcare utilization between older and younger adults. These findings affirm the safety of home OPAT in older adults. 

    Table 1. Descriptive characteristics on OPAT initiation

    Characteristic

    Age

    P value

    ≥65 years

    N=197

    < 65 years

    N=253

    Age in years, median (range)

    75 (65-105)

    54 (18-64)

    --

    Male Gender, N (%)

    125 (63%)

    150 (59%)

    0.37

    White Race, N (%)

    160 (81%)

    187 (74%)

    0.12

    Length of Stay in days, mean (STD)

    12.1 (9.5)

    12.5 (8.3)

    0.71

    Discharge Disposition

    <.0001

         Home with self-care, N (%)

    8 (4%)

    26 (10%)

         Home with services, N (%)

    41 (21%)

    107 (42%)

         SNF, N (%)

    139 (71%)

    105 (42%)

    Table 2. Healthcare utilization in 6 months after OPAT initiation

     

    SNF

    Home

     

    ≥65 years

    N=139

    <65 years

    N=105

    P value

    ≥65 years

    N=49

    <65 years

    N=133

    P value

    Hospitalizations, mean (SD)

    0.5 (1.3)

    0.3 (1.4)

    0.38

    0.5 (1.5)

    0.2 (1.1)

    0.18

    ED visits, mean (SD)

    3.1 (2.9)

    4.0 (5.7)

    0.15

    2.6 (2.5)

    2.2(2.4)

    0.26

    Office Visits, mean (SD)

    1.5 (1.4)

    1.8 (1.8)

    0.11

    1.4 (1.4)

    1.5 (1.2)

    0.84

    Phone Calls, mean (SD)

    3.0 (4.3)

    3.2 (4.9)

    0.82

    2.7 (4.0)

    2.3 (4.2)

    0.65

    Rupak Datta, MD PhD1, Kaylen Brzozowski, BS2, Joseph Canterino, MD1, Maricar Malinis, MD, FACP, FIDSA1, Vincent Quagliarello, MD, FIDSA1 and Manisha Juthani-Mehta, MD, FIDSA, FSHEA1, (1)Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, (2)Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT

    Disclosures:

    R. Datta, None

    K. Brzozowski, None

    J. Canterino, None

    M. Malinis, None

    V. Quagliarello, None

    M. Juthani-Mehta, Iterum Therapeutics: Scientific Advisor , Consulting fee .

    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.