618 - Post-discharge Care Coordination Telephone Call for Patients Enrolled in the UNC OPAT Program

Background: At hospital discharge, patients enter a transition period that carries risks for their health and access to care, particularly those receiving home infusion. In April 2019, to enhance care coordination at discharge, our OPAT program implemented a structured telephone outreach program.

Methods: Starting in April 2019, the UNC OPAT program rolled out a patient outreach intervention. Within approximately 3 days after discharge, a pharmacist or nurse coordinator called the patient or caregiver to discuss UNC’s OPAT program, review all medications and potential adverse effects, discuss home infusion and line care, schedule relevant follow-up appointments and transportation, and address patient/caregiver concerns. To evaluate dissemination and impact, we analyzed data from UNC OPAT patients from April 2019-May 2020. We abstracted EHR data for unplanned readmissions and adverse events (hepatotoxicity, nephrotoxicity, neutropenia, eosinophilia, thrombocytopenia, creatine kinase elevation, rash, Clostridioides difficile infection, line complications). We estimated risk differences (RD) to compare outcomes between contacted versus uncontacted patients. To provide context, we also assessed unplanned readmissions and adverse events in a historical control period from April 2018-March 2019, before implementation of the outreach program.

Results: After rollout of the outreach program, 374 patients completed their OPAT course and all were targeted for outreach. The success rate of contacting patients was 61%. Median age was similar between contacted and uncontacted patients (52 versus 55). Unplanned readmissions occurred less frequently for contacted patients (14% versus 21%; RD -7%; 95%CI -15%, 1%). Risk of adverse events was similar between contact groups (58% versus 54%; RD 4%; 95%CI -6%, 15%). In the historical control period (n=287, median age 56), unplanned readmission risk was 22% and adverse event risk was 63%.

Conclusion: Patients who completed the outreach phone call had lower risk of readmission compared to those who could not be reached. This intervention may be a simple, low-cost way to reduce readmissions for OPAT patients, but further study and a sustainable reimbursement structure are needed.