BackgroundThe addition of Advanced Practice Providers (APPs) such as Nurse Practitioners or Physician Assistants as hospital-based service providers has been shown to increase efficiency of care, provide for better continuity of care across the inpatient and outpatient settings, and facilitate interdisciplinary collaboration. As healthcare systems attempt to not only increase access to care but also improve quality, the addition of APPs is becoming an option to meet division-specific goals. To decrease readmissions and increase access to care for patients discharged on intravenous (IV) antibiotics and in the Outpatient Parenteral Antibiotic Therapy (OPAT) Program, the Division of Infectious Diseases at UPMC Presbyterian hired two APPs in early 2017. Our aim was to compare readmission and follow-up rates from the time before expansion of the program with APPs to after expansion.MethodsWe completed a retrospective study of all OPAT patients seen by any Infectious Diseases (ID) provider (MD or APP) n the period from January to May 2017 (prior to APP outpatient clinics with OPAT patients) and in the period from January to February 2018. The total number of patients seen by an ID provider and the 30-day readmission rates were collected and evaluated. A comparison of proportions was done with a two-tailed z-test for the percentage of readmissions prior to program expansion compared with the percentage of readmissions after program expansion.ResultsFollowing the expansion of the OPAT program with the addition of two APPs in 2017, there was a decrease, from 14.7% to 9.6%, in 30-day readmissions for all patients who were seen for follow-up (P = 0.0461, 95% CI 0.0672–9.3164). The percentage of patients who were seen for follow-up increased after expansion of the program from 29.5% to 39.3% (P = 0.0051, 95% CI 2.8714–16.9153).ConclusionExpansion of the OPAT program within the Division of Infectious Diseases at UPMC with the addition of two APPs has significantly increased access to care and significantly decreased 30-day readmissions when the patient was seen for follow-up by an ID provider (MD or APP).Disclosures All authors: No reported disclosures.
BackgroundOPAT is a well-established model of care for the monitoring of patients requiring long-term IV antibiotics1. We have previously reported a reduction in the 30-day readmission rate to our facility for patients managed in our OPAT program. However, little has been published to date regarding outcomes in OPAT patients over 80 years of age 2–3. Our OPAT program was established in 2013. Patients can be discharged to a facility or home to complete their course of antibiotics.MethodsWe conducted a retrospective chart review of all OPAT patients discharged from our facility from 2015 to 2018. Patients were divided into two groups based on age, <80 (n = 4618) and >80 (n = 562).ResultsPatient demographics are listed in Table 1. The overall 30-day readmission rate for patients older than 80 was 27.8%. For patients over 80 that had a follow-up ID clinic appointment, the 30-day readmission rate decreased to 15.7%. For patients younger than 80, the 30-day readmission rate was 36.0% with a decrease to 16.2% if patients were evaluated in the outpatient clinic. Figure 1. Staphylococcus Aureus was the predominant organism in both age categories. Vancomycin was the most common antibiotic used in both age groups followed by β lactams.ConclusionIn general, patients aged over 80 years were more likely to be discharged to a facility to complete their antibiotic course than younger patients. These patients also were more likely to have other comorbidities. The 30-day readmission rate in each age group was relatively similar. OPAT in patients over age 80 can have similar 30-day readmission rates as for patients less than 80 years of age Disclosures All authors: No reported disclosures.
BackgroundThe Outpatient Parenteral Antibiotic Therapy Program at the University Of Pittsburgh Medical Center began in December 2013. UPMC Presbyterian is a Level I center consisting of 775 beds (150 ICU beds). Prior to program implementation, the 30-day readmission rate for patients discharged from our facility on an IV antibiotic was 32%.MethodsOur Program is a multidisciplinary team consisting of physicians, advance practice providers, pharmacists, nurses, and coordinators. We use a pharmacist-based monitoring program to review weekly laboratories and adjust dosing through a collaborative practice agreement. ID fellows participate in the management of patients while receiving IV antibiotics. Patients are evaluated one week post discharge and prior to end of therapy in the ID clinic. Weekly laboratories are monitored as per the IDSA Society Guidelines. In addition, all patients all reviewed in our weekly huddle prior to end of therapy. We also conduct a monthly M&M to review readmissions.ResultsOur overall patient population has increased from 847 in 2014 to 1,234 in 2015 to 1,569 in 2016 and 1,512 patients in 2017. Post-implementation, we have demonstrated an ongoing reduction in 30-day readmission rates. In 2014, our rate decreased to 17.2%, in 2015 to 15.6%, in 2016 to 11.5% and in 2017 to 18.5% (see Figure 1). 2,337 (54%) of patients were male; the average age of our patients was 56.4 years. 35% were diabetics; 35% have chronic kidney disease, 25.4% have CAD and 43.7% have HTN. More patients are discharged home (n = 2,246) vs. to a facility (n = 1,583). Over half of our patients receive vancomycin.Figure 1.ConclusionA pharmacist managed OPAT Program can successfully reduce and maintain lower 30-day readmission rates in an academic facility.Disclosures All authors: No reported disclosures.
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