Prevalence and Risk Factors for Receiving an Antibiotic Prescription upon Discharge to Hospice Care (S722)

Abstract

1.Cite the percentage of inpatient discharges that are directly to hospice care and describe the characteristics of these patients.2.Cite the prevalence of outpatient antibiotic prescriptions for patients discharged from the hospital directly to hospice care.3.Identify patients at increased risk for continued antibiotic use in hospice care. Patients receiving antibiotics upon discharge to hospice care may be at increased risk of continued antibiotic use following transition. We quantified the prevalence and risk factors for receiving an antibiotic prescription upon discharge from acute care to hospice care. This was a cross-sectional study among adult (age >18 years) inpatients discharged to hospice care from Oregon Health & Science University (OHSU) from 1/1/2010-12/31/2012. Data were collected from the OHSU research data warehouse and Department of Care Management. Admissions of <24 hours were excluded. Antibiotic prescriptions upon discharge to hospice were defined using outpatient medication orders. Among 62,796 adult inpatient discharges, 846 (1.4%) were directly to hospice care (60% home and 40% facility). Most patients discharged to hospice had a cancer diagnosis (57%), were >65 years old (53%), had a length of hospital stay (LOS) >6 days (51%), had a palliative care consult (80%), and had completed a Physician Orders for Life Sustaining Therapy (POLST) form prior to discharge (67%), p<0.05 for all. Prevalence of antibiotic prescription upon discharge to hospice care was 22% (26% home and 15% facility: 15%). Among patients with an antibiotic prescription, 77% had an infectious diagnosis, the most common of which were urinary tract infections (20%) and septicemia (15%). Independent risk factors for antibiotic prescription upon discharge to hospice were LOS >6 days (adjusted odds ratio=1.42, 95% confidence interval=1.02-1.99) and discharge to home hospice care (adjusted odds ratio=2.19, 95% confidence interval=1.52-3.15). A large proportion of patients discharged from the hospital to hospice care received a prescription for antibiotics upon discharge. Patients with a LOS >6 days and those discharged to home hospice had an increased risk of having an antibiotic prescription.