1939. Socioeconomic Predictors of Hospital Readmission in Outpatient Parenteral Antimicrobial Therapy (OPAT) Patients

Abstract

Background. OPAT is a safe and effective treatment strategy, but hospital readmissions are common. Several studies have identified risk factors for readmission among OPAT patients, including comorbidities and care-related factors; however, no study has described such a relationship with socioeconomic factors. The purpose of this study was to identify socioeconomic predictors of hospital readmission in OPAT patients. Methods. A retrospective review was conducted of 410 OPAT patients, treated at a major tertiary care medical center, from September 2016 to March 2017. OPAT related demographic, clinical, and laboratory data were collected. Factors found to be significant in univariate analysis were included in a multivariate logistic regression model that adjusted for comorbidities, infection diagnosis, antibiotic type, and duration of therapy to determine socioeconomic factors associated with unplanned OPAT readmission. The at-risk period for readmission was defined as duration of OPAT plus 7 days. Results. Of the 410 patients, 101 (25%) experienced an unplanned readmission during the at risk period (41% females, mean age 56). OPAT-related admissions were primarily due to worsening infection (n = 36), or adverse drug reactions (n = 16), but 41% of readmissions were unrelated to OPAT or underlying infection, see figure. In an unadjusted analysis, factors associated with readmission were age, black race, CHF, valvular heart disease, PVD, length of hospital stay, ICU admission, and >1 hospitalization in the past year. Significant socioeconomic factors included living in an urban setting, lower income, and not having Medicare with secondary private insurance. In a multivariate logistic regression model, factors that remained significant included black race (OR 2, 95% CI 1.1-3.7), age 18-30 (OR 3.7, 95% CI 1.6-8.6), age 60-70 (OR 2, 95% CI 1.1-3.5), PVD (OR 2.3, 95% CI 1.1-5), and >1 hospitalization in the past year (OR 2.2, 95% CI 1.3-3.9), while having Medicare with private insurance was protective (OR 0.3, 95% CI 0.1-0.7). Conclusion. Socioeconomic factors are significant contributors for unplanned hospital readmission among OPAT patients and should be included when identifying high-risk patients for targeted risk reduction interventions. (Figure Presented).