Patients prescribed outpatient parenteral antimicrobial therapy, or OPAT, at hospital discharge are at risk for hospital readmission, but easily obtainable clinical characteristics can be used to identify those patients at highest risk for readmission, according to new study data.
“Despite the benefits of OPAT, the delivery of potentially toxic therapies outside the acute hospital setting has the potential for complications including hospital readmissions,” researchers wrote in Clinical Infectious Diseases. “Thirty-day readmissions are currently receiving particularly intense scrutiny and have been proposed as health care quality markers. Patient outcomes with OPAT could be further improved if rates of unplanned readmissions could be predicted and reduced.”
The study included 782 patients (mean age, 58 years) who were discharged with IV antibiotics from Tufts Medical Center between 2009 and 2011. The researchers collected data on patient demographics, comorbidities, infections and antibiotic classes.
The most common diagnoses in the cohort were bacteremia (24%), osteomyelitis (20%) and pyelonephritis (13%). According to the researchers, 26% of the patients were readmitted to the hospital. The most common indications for readmission included non-infection-related conditions (30%), worsening infections (29%) and new infections (19%).
Additional analyses indicated several variables associated with an increased risk for readmission, including age (OR=1.09; 95% CI, 0.99-1.21), aminoglycoside use (OR=2.33; 95% CI, 1.17-4.57), resistant organisms (OR=1.57; 95% CI, 1.03-2.36), and the number of prior hospital discharges without IV antimicrobial use in the past year (OR=1.2 per prior hospital admission; 95% CI, 1.09-1.32). Patients at the greatest risk had nearly a threefold higher rate of hospital readmissions (43.6%; 95% CI, 35.8-51.4) vs. patients at the lowest risk (17.8%; 95% CI, 11.8-23.9).
“This study indicates the high risk of readmission for OPAT patients, and the need to develop evidence-based interventions to prevent OPAT readmissions using appropriate risk stratification to ensure that efforts target the highest-risk patients,” the researchers concluded.
Disclosure: See the study for a full list of financial disclosures.
Source: healio.com