1932. Healthcare Utilization in Older vs. Younger Adults on Outpatient Parenteral Antimicrobial Therapy According to Discharge Location

Abstract

BackgroundOlder adults may require increased supervision during outpatient parenteral antimicrobial therapy (OPAT), particularly those discharged home vs. a skilled nursing facility (SNF).MethodsWe performed a quality improvement project of all patients initiated on OPAT during admission to Yale New Haven Hospital between October 1, 2016 and September 30, 2017. Descriptive data were collected. Healthcare utilization according to discharge location was assessed in older (age ≥65 years) vs. younger (age <65 years) adults in the 6 months following OPAT initiation. Differences between groups were assessed using x2 and t tests.ResultsWe identified 450 patients initiated on OPAT. Table 1 shows descriptive characteristics. Median OPAT duration was 31 days (range 1–155) for older adults and 34 days (range 1–183) for younger adults. Discharge to skilled nursing facility (SNF) was more likely in older (71%, N = 139/197) vs. younger (42%, N = 105/253) adults (P < 0.0001) following OPAT initiation. However, there was no difference in healthcare utilization according to discharge location (Table 2). Healthcare utilization was also similar between older and younger adults across antimicrobials (Figure 1).Table 1:Descriptive Characteristics on OPAT InitiationCharacteristicAge P-Value≥65 Years, N = 197<65 Years, N = 253Age in years, median (range)75 (65–105)54 (18–64)–Male gender, N (%)125 (63%)150 (59%)0.37White race, N (%)160 (81%)187 (74%)0.12Length of stay in days, mean (STD)12.1 (9.5)12.5 (8.3)0.71Discharge disposition<0.0001 Home with self-care, N (%)8 (4%)26 (10%) Home with services, N (%)41 (21%)107 (42%) SNF, N (%)139 (71%)105 (42%)Table 2.Healthcare Utilization in 6 Months After OPAT InitiationSNFHome≥65 Years, N = 139<65 Years, N = 105 P Value≥65 Years, N = 49<65 Years, N = 133 P ValueHospitalizations, mean (SD)0.5 (1.3)0.3 (1.4)0.380.5 (1.5)0.2 (1.1)0.18ED visits, mean (SD)3.1 (2.9)4.0 (5.7)0.152.6 (2.5)2.2(2.4)0.26Office visits, mean (SD)1.5 (1.4)1.8 (1.8)0.111.4 (1.4)1.5 (1.2)0.84Phone calls, mean (SD)3.0 (4.3)3.2 (4.9)0.822.7 (4.0)2.3 (4.2)0.65 ConclusionRegardless of discharge home vs. SNF, there was no difference in healthcare utilization between older and younger adults. These findings affirm the safety of home OPAT in older adults.Disclosures M. Juthani-Mehta, Iterum Therapeutics: Scientific Advisor, Consulting fee.