2081. Low 30-Day Hospital Readmission Rates in Medicare Patients Receiving Outpatient Parenteral Antimicrobial Therapy (OPAT) in Physician Office Infusion Centers

BACKGROUND: The Hospital Readmissions Reduction Program was established under the Affordable Care Act in 2012 to reduce payments to hospitals (hosp) with excess readmissions. Standardized readmission measures include all-cause unplanned readmissions within 30 days of hosp discharge, regardless of initial diagnosis. To avoid penalties, post-acute care, including OPAT, must have a neutral or favorable impact on 30-day hosp readmissions (30-dHR). We assessed 30-dHR for Medicare (MCR) patients receiving OPAT in ID physician office infusion centers (POICs). METHODS: All records of MCR patients were identified that were discharged from hosp to 15 national ID POICs. From those, 200 records were randomly selected and reviewed for unplanned 30-dHR. Additional data extracted were demographics, Charlson comorbidities index (CCI), infection diagnosis, therapy and reasons for readmission. The 30-dHR was compared with national average estimates obtained from the Medical Expenditure Panel Survey (MEPS) database. Multivariate logistic regression was performed with P < 0.05 being statistically significant. RESULTS: Mean pt age was 73.5 years (range: 65–97) with 56% males. Infections included bone and joint (34%), genitourinary (16%), complicated skin and skin structure (15%), bacteremia (13%), respiratory (10%), intra-abdominal (7%), endocarditis (2.5%), and central nervous system (2.5%) with a mean OPAT duration of 21 ± 18 days. Overall, 30-day HR rate was 11% (n = 22). Median days from initial hosp discharge to readmission was 13 (range 2–28). Reasons for 30-day HR included disease exacerbation unrelated to infection (n = 7, 32%), worsening infection (n = 6, 27%), adverse drug reaction (n = 5, 23%), new infection (n = 3, 14%), and line complication (n = 1, 4%). A logistic regression model (Table 1) indicates that 30-day HR rates reported in MEPS are significantly higher than observed for patients treated with OPAT in POICs after adjustment for age, gender, CCI and initial diagnosis (OR = 3.16, 95% CI: 1.89–5.28, P < 0.0001). CONCLUSION: Patients receiving OPAT in POICs had significantly lower 30-day HRs compared with a national average, and in a more comorbid population. Our data suggest that continuous oversight of patients by ID physicians and infusion center staff in the POIC setting may prevent hospital readmissions. [Image: see text] DISCLOSURES: All authors: No reported disclosures.