Bundle in the bronx: Impact of a transition-of-care outpatient parenteral antibiotic therapy bundle on all- cause 30-day hospital readmissions

Theresa Madaline, Priya Nori, Wenzhu Bi Mowrey, Elisabeth Zukowski, Shruti Gohil, Uzma N. Sarwar, Gregory D. Weston, Riganni Urrely, Matthew Palombelli, Vinnie Frank Pierino, Vanessa Parsons, Amy R. Ehrlich, Belinda Ostrowsky, Marilou Corpuz, Liise-anne Pirofski

Research output: Contribution to journalArticle

12 Citations (Scopus)

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.

Original languageEnglish (US)
Article numberofx097
JournalOpen Forum Infectious Diseases
Volume4
Issue number2
DOIs
StatePublished - Mar 1 2017

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Patient Transfer
Patient Readmission
Outpatients
Anti-Bacterial Agents
Therapeutics
Confidence Intervals
Group Psychotherapy
Hospital Emergency Service
Odds Ratio
Social Adjustment
Mortality
Vulnerable Populations
Standard of Care
Ambulatory Care
Proportional Hazards Models
Inpatients
Logistic Models

Keywords

  • Bundle
  • Outpatient parenteral antibiotic therapy
  • Readmission
  • Transitional care model

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

Cite this

Bundle in the bronx : Impact of a transition-of-care outpatient parenteral antibiotic therapy bundle on all- cause 30-day hospital readmissions. / Madaline, Theresa; Nori, Priya; Mowrey, Wenzhu Bi; Zukowski, Elisabeth; Gohil, Shruti; Sarwar, Uzma N.; Weston, Gregory D.; Urrely, Riganni; Palombelli, Matthew; Pierino, Vinnie Frank; Parsons, Vanessa; Ehrlich, Amy R.; Ostrowsky, Belinda; Corpuz, Marilou; Pirofski, Liise-anne.

In: Open Forum Infectious Diseases, Vol. 4, No. 2, ofx097, 01.03.2017.

Research output: Contribution to journalArticle

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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.",
keywords = "Bundle, Outpatient parenteral antibiotic therapy, Readmission, Transitional care model",
author = "Theresa Madaline and Priya Nori and Mowrey, {Wenzhu Bi} and Elisabeth Zukowski and Shruti Gohil and Sarwar, {Uzma N.} and Weston, {Gregory D.} and Riganni Urrely and Matthew Palombelli and Pierino, {Vinnie Frank} and Vanessa Parsons and Ehrlich, {Amy R.} and Belinda Ostrowsky and Marilou Corpuz and Liise-anne Pirofski",
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T2 - Impact of a transition-of-care outpatient parenteral antibiotic therapy bundle on all- cause 30-day hospital readmissions

AU - Madaline, Theresa

AU - Nori, Priya

AU - Mowrey, Wenzhu Bi

AU - Zukowski, Elisabeth

AU - Gohil, Shruti

AU - Sarwar, Uzma N.

AU - Weston, Gregory D.

AU - Urrely, Riganni

AU - Palombelli, Matthew

AU - Pierino, Vinnie Frank

AU - Parsons, Vanessa

AU - Ehrlich, Amy R.

AU - Ostrowsky, Belinda

AU - Corpuz, Marilou

AU - Pirofski, Liise-anne

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N2 - 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.

AB - 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.

KW - Bundle

KW - Outpatient parenteral antibiotic therapy

KW - Readmission

KW - Transitional care model

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