Risk Factors Associated with Thirty-Day Readmission among Patients Receiving Outpatient Parenteral Antimicrobial Therapy Öffentlichkeit

Abstract

Outpatient parenteral antimicrobial therapy (OPAT) programs allow patients who are otherwise ready to be discharged from the hospital to receive intravenous treatment in an outpatient setting. These programs have become more popular as health policies incentivize shifting care to the outpatient setting. In this study we developed a predictive model of thirty-day readmission among hospitalized patients discharged with OPAT from two academic medical centers with a dedicated OPAT clinic for management. We used logistic regression to assess OPAT and other outpatient clinic follow-up in conjunction with age, sex, pathogen, diagnosis, discharge medication, planned length of therapy, and comorbidities using the modified Charlson score. We hypothesized that at least one follow-up visit at the Emory OPAT clinic would reduce the risk for hospital readmission within 30 days. Of the 755 eligible individuals, 137 (18%) patients were readmitted within 30 days. Most patients (73%) received some type of follow-up care at Emory Healthcare within 30 days of discharge or prior to readmission, including 52% of patients visiting the Emory OPAT clinic. The final predictive model contains type of follow-up (no visit, OPAT visit, or non-OPAT visit only), enterococci, Charlson score (≥3 vs. 0-2), discharge location (rehabilitation facility vs. home), home county (inside vs. outside metropolitan Atlanta), gastrointestinal infection, polymicrobial infection, and interaction between gastrointestinal and polymicrobial infection. This final model indicated that having an OPAT visit was associated with a 90% reduction in odds of readmission compared to those who had no follow-up visit at all, adjusted for all other variables in the model (OR 0.10, 95% CI 0.06-0.17). In a pre-specified sensitivity analysis excluding patients discharged to a rehabilitation facility or living outside metropolitan Atlanta, the odds ratio for readmission was consistent (OR 0.06, 95% CI 0.03-0.13). These results can be used as a guide to develop interventions to prevent readmissions and to study how to improve the outcomes of patients who have factors potentially putting them at increased odds of readmission.

Table of Contents

Introduction..................................1

Background...................................2

Methods........................................4

Results..........................................10

Discussion....................................15

Conclusion...................................21

References...................................22

Table 1.........................................26

Table 1a.......................................28

Table 1b.......................................30

Table 1c.......................................31

Table 2.........................................33

Table 3.........................................35

Table 4.........................................36

Figure 1........................................37

Figure 2........................................38

Figure 3........................................39

Figure 4........................................40

Figure 5........................................41

Figure 6........................................42

Figure 7........................................43

Appendix.....................................44

Supplementary Table 1................44

Supplementary Table 2................47

Supplementary Table 3................48

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Stichwort	OPAT
Committee Chair / Thesis Advisor	Jacob, Jesse Thomas, Emory University

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