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126. evaluation of Addition of Outpatient Parenteral Antimicrobial Therapy and Orthopedic ID Resources to Transitions-of-care Outcomes

BACKGROUND: Our large academic medical center initiated both an Outpatient Parenteral Antimicrobial Therapy (OPAT) program supported by an infectious disease trained pharmacist, along with an Orthopedic Infectious Disease (OID) consult service to assist in caring for these specialized populations. W...

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Autores principales: Young, Brett, Bergman, Scott, Van Schooneveld, Trevor C, Cortes-Penfield, Nicolas W, Alexander, Bryan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7778105/
http://dx.doi.org/10.1093/ofid/ofaa439.436
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author Young, Brett
Bergman, Scott
Van Schooneveld, Trevor C
Cortes-Penfield, Nicolas W
Alexander, Bryan
author_facet Young, Brett
Bergman, Scott
Van Schooneveld, Trevor C
Cortes-Penfield, Nicolas W
Alexander, Bryan
author_sort Young, Brett
collection PubMed
description BACKGROUND: Our large academic medical center initiated both an Outpatient Parenteral Antimicrobial Therapy (OPAT) program supported by an infectious disease trained pharmacist, along with an Orthopedic Infectious Disease (OID) consult service to assist in caring for these specialized populations. We measured the impact of these services. METHODS: Patients discharged on parenteral antimicrobial therapy were divided into two groups. The pre-OPAT cohort included all patient receiving OPAT from 4/1/18 - 10/31/18; the post-OPAT cohort included all patients who received OPAT from 4/1/19 - 10/31/19 with OPAT consult (Fig 1). The OID consult service began in September 2018 prior to initiation of the OPAT program. The primary outcome was 30-day hospital readmission. Secondary outcomes included: length of stay (LOS), 90-day readmission, clinical outcomes, and identification of predictors of hospital readmission. Clinical outcomes included: time from final OR visit to discharge for OID patients and optimal treatment (cefazolin, oxacillin, or nafcillin) for MSSA. [Image: see text] [Image: see text] RESULTS: Introduction of these programs was associated with a reduction in all-cause 30-day readmission from 39.3% to 22.9%, and a reduction in 30-day readmission for patients on-treatment from 24.6% to 15.6% (p< 0.01 for both). No difference was seen in hospital LOS (8 days in each cohort). In a subgroup analysis (Fig 2), OID patients in the post-OPAT cohort saw a median reduction of 2 days (7 days to 5 days, p=0.002) in time from final OR visit to discharge. Use of optimal treatments for MSSA increased in the post-OPAT cohort compared to pre-OPAT (65.2% to 80.9%; p=0.06). The 90-day hospital readmission rate were higher in the post-OPAT cohort among patients who lived in metro-area zip codes (p=0.03). Having an established primary care physician was associated with lower 90-day hospital readmission in both the pre-and post-OPAT cohorts (p=0.05 and 0.01, respectively). CONCLUSION: Thirty-day readmission rates among patients discharged on OPAT significantly lowered following initiation of a combination of both a pharmacist-led OPAT program and OID consult service. OPAT and OID programs accrue additional efficiencies and clinical benefits to both patients and hospitals, which can be further evaluated and used to justify such service additions. DISCLOSURES: All Authors: No reported disclosures
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spelling pubmed-77781052021-01-07 126. evaluation of Addition of Outpatient Parenteral Antimicrobial Therapy and Orthopedic ID Resources to Transitions-of-care Outcomes Young, Brett Bergman, Scott Van Schooneveld, Trevor C Cortes-Penfield, Nicolas W Alexander, Bryan Open Forum Infect Dis Poster Abstracts BACKGROUND: Our large academic medical center initiated both an Outpatient Parenteral Antimicrobial Therapy (OPAT) program supported by an infectious disease trained pharmacist, along with an Orthopedic Infectious Disease (OID) consult service to assist in caring for these specialized populations. We measured the impact of these services. METHODS: Patients discharged on parenteral antimicrobial therapy were divided into two groups. The pre-OPAT cohort included all patient receiving OPAT from 4/1/18 - 10/31/18; the post-OPAT cohort included all patients who received OPAT from 4/1/19 - 10/31/19 with OPAT consult (Fig 1). The OID consult service began in September 2018 prior to initiation of the OPAT program. The primary outcome was 30-day hospital readmission. Secondary outcomes included: length of stay (LOS), 90-day readmission, clinical outcomes, and identification of predictors of hospital readmission. Clinical outcomes included: time from final OR visit to discharge for OID patients and optimal treatment (cefazolin, oxacillin, or nafcillin) for MSSA. [Image: see text] [Image: see text] RESULTS: Introduction of these programs was associated with a reduction in all-cause 30-day readmission from 39.3% to 22.9%, and a reduction in 30-day readmission for patients on-treatment from 24.6% to 15.6% (p< 0.01 for both). No difference was seen in hospital LOS (8 days in each cohort). In a subgroup analysis (Fig 2), OID patients in the post-OPAT cohort saw a median reduction of 2 days (7 days to 5 days, p=0.002) in time from final OR visit to discharge. Use of optimal treatments for MSSA increased in the post-OPAT cohort compared to pre-OPAT (65.2% to 80.9%; p=0.06). The 90-day hospital readmission rate were higher in the post-OPAT cohort among patients who lived in metro-area zip codes (p=0.03). Having an established primary care physician was associated with lower 90-day hospital readmission in both the pre-and post-OPAT cohorts (p=0.05 and 0.01, respectively). CONCLUSION: Thirty-day readmission rates among patients discharged on OPAT significantly lowered following initiation of a combination of both a pharmacist-led OPAT program and OID consult service. OPAT and OID programs accrue additional efficiencies and clinical benefits to both patients and hospitals, which can be further evaluated and used to justify such service additions. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2020-12-31 /pmc/articles/PMC7778105/ http://dx.doi.org/10.1093/ofid/ofaa439.436 Text en © The Author 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Poster Abstracts
Young, Brett
Bergman, Scott
Van Schooneveld, Trevor C
Cortes-Penfield, Nicolas W
Alexander, Bryan
126. evaluation of Addition of Outpatient Parenteral Antimicrobial Therapy and Orthopedic ID Resources to Transitions-of-care Outcomes
title 126. evaluation of Addition of Outpatient Parenteral Antimicrobial Therapy and Orthopedic ID Resources to Transitions-of-care Outcomes
title_full 126. evaluation of Addition of Outpatient Parenteral Antimicrobial Therapy and Orthopedic ID Resources to Transitions-of-care Outcomes
title_fullStr 126. evaluation of Addition of Outpatient Parenteral Antimicrobial Therapy and Orthopedic ID Resources to Transitions-of-care Outcomes
title_full_unstemmed 126. evaluation of Addition of Outpatient Parenteral Antimicrobial Therapy and Orthopedic ID Resources to Transitions-of-care Outcomes
title_short 126. evaluation of Addition of Outpatient Parenteral Antimicrobial Therapy and Orthopedic ID Resources to Transitions-of-care Outcomes
title_sort 126. evaluation of addition of outpatient parenteral antimicrobial therapy and orthopedic id resources to transitions-of-care outcomes
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7778105/
http://dx.doi.org/10.1093/ofid/ofaa439.436
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