A transition-of-care outpatient parenteral antibiotic therapy bundle reduced all-cause 30-day hospital readmissions compared to standard care (13.0% vs 26.1%; adjusted OR 0.51, 95% CI 0.27-0.94).
Cohort (n=330)
No
Does a transition-of-care OPAT bundle reduce all-cause 30-day hospital readmissions in patients receiving postdischarge intravenous antibiotics?
Implementation of a transition-of-care OPAT bundle significantly reduced 30-day hospital readmissions compared to standard care.
Effect estimate: OR 0.51 (95% CI 0.27-0.94)
Absolute Event Rate: 13% vs 26.1%
p-value: p=0.03
Abstract Background 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. Methods 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 χ2 test 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. Results 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. Conclusions 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.
Madaline et al. (Sun,) conducted a cohort in Patients receiving postdischarge intravenous antibiotics (n=330). Transition-of-care outpatient parenteral antibiotic therapy (TOC-OPAT) bundle vs. Previous standard care was evaluated on All-cause 30-day hospital readmission (OR 0.51, 95% CI 0.27-0.94, p=0.03). A transition-of-care outpatient parenteral antibiotic therapy bundle reduced all-cause 30-day hospital readmissions compared to standard care (13.0% vs 26.1%; adjusted OR 0.51, 95% CI 0.27-0.94).