596 - Clinical outcomes and healthcare utilization in uninsured patients requiring long-term antibiotic therapy

Background: Outpatient parenteral antimicrobial therapy (OPAT) is frequently indicated in the management of severe bacterial infections. Uninsured patients may more have difficulties accessing OPAT services (compared to those with a payer source) which can lead to prolonged hospitalizations or early discharge with potentially suboptimal therapy. We sought to assess disparities in the care of hospitalized, uninsured patients who had an OPAT indication and to examine subsequent clinical outcomes.

Methods: We performed a retrospective analysis of consecutive patients admitted to an academic hospital from 09/01/2018-12/31/2018 who received an infectious diseases consultation and had an index diagnosis of endocarditis (IE), Staphylococcus aureus BSI, or bone and joint infection including osteomyelitis, prosthetic joint infection, and septic arthritis identified by ICD-10 code. Clinical data were collected during index admission; outcomes were followed for up to 30 days after discharge. We examined differences in length of stay (LOS), discharge against medical advice (AMA), and composite outcome of death and readmission at 30 days in uninsured and privately insured patients.

Results: Of 104 patients, 66 (63.5%) were privately insured and 38 (36.5%) were uninsured. Baseline clinical characteristics are presented in Table 1. Uninsured patients were younger (40.9 versus 51.4 years, p< 0.001) and more likely to be African American (55.3% versus 19.7%, p< 0.001). Uninsured patients were more likely to leave AMA (18.4% versus 0%, p=0.001), complete shorter duration of IV antibiotics (p=0.001), and receive oral antibiotics at discharge (15.8% versus 3.0%, p=0.049). Length of stay was numerically longer in this group although not significant (15.5 days versus 10 days, p=0.053). Composite outcome of readmission or death from all cause at 30 days was lower in the uninsured group; however, after adjusting for age, the results were not significant (aOR 0.372, 95% CI 0.106-1.297, p=0.121).Table 1. Demographic and clinical characteristics of privately insured and uninsured patients


Conclusion: Uninsured patients were more likely to leave AMA, complete shorter duration of IV antibiotics, and receive oral antibiotics at discharge compared with privately insured patients. Thirty-day readmission and death rates were not significantly different among the two groups.