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Bundle in the Bronx: Impact of a Transition-of-Care Outpatient Parenteral Antibiotic Therapy Bundle on All-Cause 30-Day Hospital Readmissions.

  • Author(s): Madaline, Theresa
  • Nori, Priya
  • Mowrey, Wenzhu
  • Zukowski, Elisabeth
  • Gohil, Shruti
  • Sarwar, Uzma
  • Weston, Gregory
  • Urrely, Riganni
  • Palombelli, Matthew
  • Pierino, Vinnie Frank
  • Parsons, Vanessa
  • Ehrlich, Amy
  • Ostrowsky, Belinda
  • Corpuz, Marilou
  • Pirofski, Liise-Anne
  • et al.
Creative Commons Attribution 4.0 International Public License
Abstract

A streamlined transition from inpatient to outpatient care can decrease 30-day readmissions. Outpatient parenteral antibiotic therapy (OPAT) programs have not reduced readmissions; an OPAT bundle has been suggested to improve outcomes. We implemented a transition-of-care (TOC) OPAT bundle and assessed the effects on all-cause, 30-day hospital readmission.

Retrospectively, patients receiving postdischarge intravenous antibiotics were evaluated before and after implementation of a TOC-OPAT program in Bronx, New York, between July, 2015 and February, 2016. Pearson's χ2test was used to compare 30-day readmissions between groups, and logistic regression was used to adjust for covariates. Time from discharge to readmission was analyzed to assess readmission risk, using log-rank test to compare survival curves and Cox proportional hazards model to adjust for covariates. Secondary outcomes, 30-day emergency department (ED) visits, and mortality were analyzed similarly.

Compared with previous standard care (n = 184), the TOC-OPAT group (n = 146) had significantly lower 30-day readmissions before (13.0% vs 26.1%,P< .01) and after adjustment for covariates (odds ratio [OR] = 0.51; 95% confidence interval [CI], 0.27-0.94;P= .03). In time-dependent analyses, TOC-OPAT patients were at significantly lower risk for readmission (log-rank test,P< .01; hazard ratio = 0.56; 95% CI, 0.32-0.97;P= .04). Propensity-matched sensitivity analysis showed lower readmissions in the TOC-OPAT group (13.6% vs 24.6%,P= .04), which was attenuated after adjustment (OR = 0.51; 95% CI, 0.25-1.05;P= .07). Mortality and ED visits were similar in both groups.

Our TOC-OPAT patients had reduced 30-day readmissions compared with the previous standard of care. An effective TOC-OPAT bundle can successfully improve patient outcomes in an economically disadvantaged area.

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