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Prediction Model for 30-day Hospital Readmissions among Patients Discharged Receiving Outpatient Parenteral Antibiotic Therapy (OPAT).
Clin Infect Dis. 2013 Dec 19;
Authors: Allison GM, Muldoon EG, Kent D, Paulus JK, Ruthazer R, Ren A, Snydman DR
Abstract
Introduction Factors associated with readmission for patients prescribed outpatient parenteral antibiotic therapy (OPAT) at hospital discharge have not been definitively identified. The study aim was to develop a model of 30-day readmissions for OPAT patients. Methods A database comprising 782 OPAT patients treated between 2009 and 2011 at a single academic center was created. Variables collected included patient demographics, comorbidities, infections, and antibiotic classes. Final model discrimination was assessed using the c-statistic and calibration was examined graphically. Results Mean patient age was 58 years (range 18-95), 43% were women, and most common diagnoses were bacteremia (24%), osteomyelitis (20%), and pyelonephritis (13%). The unplanned 30-day readmission rate was 26%. The leading indications for readmission were: non-infection related (30%), worsening infection (29%) and new infection (19%). The final regression model consisted of age (Odds Ratio 1.09 per decade, 95% confidence interval 0.99, 1.21), aminoglycoside use (OR 2.33, 95% CI 1.17, 4.57), resistant organisms (OR 1.57, 95% CI 1.03, 2.36), and number of prior hospital discharges without intravenous antibiotics in the past 12 months (OR 1.2 per prior admission, 95% CI 1.09-1.32). The c-statistic was 0.61 and the highest risk quintile of patients had nearly a 3-fold higher rate of readmission compared to the lowest. Conclusions Patients prescribed OPAT are at risk for readmission. A subgroup of patients at especially high risk can be identified using easily obtainable clinical characteristics at the time of hospital discharge. More intensive interventions to prevent OPAT readmissions should be targeted and tested with those at highest risk.
PMID: 24357220 [PubMed - as supplied by publisher]