Bundle in the Bronx: Impact of a Transition-of-Care Outpatient Parenteral Antibiotic Therapy Bundle on All-Cause 30-Day Hospital Readmissions

Author:

Madaline Theresa1,Nori Priya1,Mowrey Wenzhu2,Zukowski Elisabeth3,Gohil Shruti4,Sarwar Uzma1,Weston Gregory1,Urrely Riganni5,Palombelli Matthew5,Pierino Vinnie Frank5,Parsons Vanessa5,Ehrlich Amy6,Ostrowsky Belinda1,Corpuz Marilou1,Pirofski Liise-anne17

Affiliation:

1. Division of Infectious Diseases, Department of Medicine

2. Division of Biostatistics, Department of Epidemiology and Population Health and

3. New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of STD Prevention and Control, New York; and

4. Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine

5. Department of Medicine, and

6. Division of Geriatrics, Department of Medicine, Montefiore Medical Center

7. Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York

Abstract

Abstract Background A streamlined transition from inpatient to outpatient care can decrease 30-day readmissions. Outpatient parenteral antibiotic therapy (OPAT) programs have not reduced readmissions; an OPAT bundle has been suggested to improve outcomes. We implemented a transition-of-care (TOC) OPAT bundle and assessed the effects on all-cause, 30-day hospital readmission. Methods Retrospectively, patients receiving postdischarge intravenous antibiotics were evaluated before and after implementation of a TOC-OPAT program in Bronx, New York, between July, 2015 and February, 2016. Pearson’s χ2 test was used to compare 30-day readmissions between groups, and logistic regression was used to adjust for covariates. Time from discharge to readmission was analyzed to assess readmission risk, using log-rank test to compare survival curves and Cox proportional hazards model to adjust for covariates. Secondary outcomes, 30-day emergency department (ED) visits, and mortality were analyzed similarly. Results Compared with previous standard care (n = 184), the TOC-OPAT group (n = 146) had significantly lower 30-day readmissions before (13.0% vs 26.1%, P < .01) and after adjustment for covariates (odds ratio [OR] = 0.51; 95% confidence interval [CI], 0.27–0.94; P = .03). In time-dependent analyses, TOC-OPAT patients were at significantly lower risk for readmission (log-rank test, P < .01; hazard ratio = 0.56; 95% CI, 0.32–0.97; P = .04). Propensity-matched sensitivity analysis showed lower readmissions in the TOC-OPAT group (13.6% vs 24.6%, P = .04), which was attenuated after adjustment (OR = 0.51; 95% CI, 0.25–1.05; P = .07). Mortality and ED visits were similar in both groups. Conclusions Our TOC-OPAT patients had reduced 30-day readmissions compared with the previous standard of care. An effective TOC-OPAT bundle can successfully improve patient outcomes in an economically disadvantaged area.

Funder

Albert Einstein College of Medicine

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Oncology

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