Early ID Outpatient Follow-up of OPAT Patients Reduces 30-day Readmission

Abstract

BackgroundAlthough 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.MethodsWe 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).ResultsOf 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.ConclusionInfectious 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.Disclosures All authors: No reported disclosures.

Assessing the utilization and impact of a newly established outpatient parenteral antimicrobial therapy (OPAT) program

“…We were most interested in determining whether implementation of the ID physician-led OPAT clinic led to appreciable differences in health outcomes. ID supervision of OPAT is routinely recommended by published guidelines, and several recent studies have demonstrated the importance of ID involvement in reducing readmissions and health care costs (2,3,16,17). In our study, although we found no significant change in 60-day readmission rate, there was a trend toward reduced ED use and readmissions.…”

Factors associated with successful completion of outpatient parenteral antibiotic therapy in an area with a high prevalence of multidrug-resistant bacteria: 30-day hospital admission and mortality rates

“…Palms et al developed a 30-day admission predictive model for patients discharged to OPAT and found that follow-up at a clinic specialising in infectious diseases was a preventive factor for hospital admission [23]. Saini et al demonstrated that evaluation by an infectious diseases specialist within the first 14 days after enrolment in an OPAT program is associated with a lower risk of hospital admission within the first 30 days after discharge [24]. To our knowledge, there have been no studies establishing a direct relationship between post-enrolment evaluation and mortality.…”

Crossover Cases of High‐Conflict Families Involving Child Protection Services: Ontario Research Findings and Suggestions for Good Practices

“…2 In some jurisdictions, CPS may become involved with a high-conflict family when one or both parents report that the other parent (or a new partner) is abusing or neglecting the child or that drug or alcohol abuse or mental health issues are compromising the caring capacity of the other parent. 3 Custodial and noncustodial parents are the primary referral source for allegations in the context of child custody disputes. 4 CPS may also become involved because of risk of harm to the children due to exposure to high levels of conflict.…”