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

Abstract

BackgroundThe 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).MethodsAll 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.ResultsMean 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).ConclusionPatients 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. Disclosures All authors: No reported disclosures.