scholarly journals 624. Significant Institutional Cost Savings from OPAT-Facilitated Discharge for Patients with Challenging Situations

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S371-S372
Author(s):  
Bryan Alexander ◽  
Scott Bergman ◽  
Trevor C Van Schooneveld ◽  
Nicolas W Cortes-Penfield
Keyword(s):  
Infectious Disease ◽  
Program Implementation ◽  
Private Insurance ◽  
Cost Savings ◽  
Pharmaceutical Manufacturer ◽  
Inpatient Setting ◽  
Matched Cohort ◽  
Program Cost ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Days Of Therapy

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) programs are becoming a standard of care, however, program cost justification remains a challenge. One area of focus for institutions is facilitating timely discharge from the inpatient setting, and difficult to discharge patients are a group with which OPAT teams can be particularly impactful. Methods This retrospective review identified patients intervened upon by the Nebraska Medicine OPAT team during the initial nine months after program implementation (4/1/19 - 12/31/19) for which routine efforts at discharge by primary teams had failed. Patients were planned for extended inpatient stays to complete the full duration of parenteral antibiotic therapy due to discharge issues given the therapy plan initially recommended by infectious disease consult teams. Outcomes evaluated included inpatient days of therapy avoided, associated financial metrics, and 30-day readmission rates. A matched cohort of patients with similar lengths-of-stay, infectious disease indications, medication use, and lack of major complications was identified to calculate a cost per inpatient day avoided. Results A total of 17 difficult to discharge patients were intervened on by the OPAT team, leading to avoidance of 429 planned inpatient days. Based on calculation from internal matched cohort data, these OPAT interventions avoided an estimated $943,000 in total inpatient costs. All-cause 30-day readmission was 24% (4 of 17 patients). Additionally, 15 of these therapy courses were shifted to hospital-associated outpatient infusion centers. Facilitation of enrollment for 11 of these patients in pharmaceutical manufacturer patient assistance programs resulted in replacement of outpatient medication totaling over $28,000 in value. Reimbursements for two additional patients through either governmental or private insurance generated over $11,000 in margin for the health system. Conclusion Attention to complex discharge facilitation by OPAT programs can be a significant contribution to program cost justification, while also transitioning patients to therapy plans that lead to similar clinical outcomes when compared to the overall OPAT population. Disclosures All Authors: No reported disclosures

scholarly journals Infectious Disease Team Review Using Antibiotic Switch and Discharge Criteria Shortens the Duration of Intravenous Antibiotic: A Single-Center Cluster-Randomized Controlled Trial in Thailand

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Thanyarak Wongkamhla ◽  
Buddharat Khan-asa ◽  
Sasima Tongsai ◽  
Nasikarn Angkasekwinai
Keyword(s):  
Infectious Disease ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Cluster Randomized Controlled Trial ◽  
Defined Daily Dose ◽  
Randomized Controlled ◽  
Days Of Therapy ◽  
Significant Difference ◽  
Cluster Randomized ◽  
Discharge Criteria

Abstract Background Strategies have been recommended to optimize early antibiotic (ATB) switching from intravenous (IV) to oral ATB. This study aimed to determine whether infectious disease (ID) team review using ATB switch and discharge criteria would shorten the duration of IV ATB and length of hospital stay (LOS). Methods This cluster-randomized controlled trial was conducted in 8 general medical wards as cluster units at Siriraj Hospital during January–October 2019. The ID team review with checklist criteria was performed on the third, fifth, and seventh day of IV-ATB treatment to determine (1) the suitability of switching to oral ATB or outpatient parenteral ATB therapy and (2) early discharge for patients receiving IV-ATB versus control. The primary outcomes were LOS and the duration or days of therapy (DOT) or defined daily dose (DDD) of IV-ATB therapy. Results Four wards each were randomly assigned to the intervention and control groups (46 patients/cluster, 184 patients/arm). No significant difference was observed between intervention and controls for median duration of IV-ATB therapy (7 vs 7 days) and LOS (9 vs 10 days). A significantly shorter duration of IV ATB was observed in patients without sepsis in the intervention group when measured by DOT (7 vs 8 days, P = .027) and DDD (7 vs 9, P = .017) in post hoc analysis. Conclusions Infectious disease team review using checklist criteria did not result in a shorter duration of IV-ATB and LOS in overall patients. Further study is needed to determine whether faster culture turnaround time or advanced testing will reduce the duration of IV-ATB therapy.

scholarly journals Fewer hospitalizations and prolonged technique survival with Home Hemodialysis– a matched cohort study from the Swedish Renal Registry

2019 ◽  
Author(s):  
Helena Rydell ◽  
Kerstin Ivarsson ◽  
Martin Almquist ◽  
Naomi Clyne ◽  
Mårten Segelmark
Keyword(s):  
Infectious Disease ◽  
Hospital Admissions ◽  
Admission Rate ◽  
European Population ◽  
Matched Cohort ◽  
Home Hemodialysis ◽  
Swedish Population ◽  
Technique Survival ◽  
Start Date ◽  
Dialysis Technique

Abstract Background Patients on home hemodialysis (HHD) exhibit superior survival compared with patients on institutional hemodialysis (IHD) and peritoneal dialysis (PD). There is a sparsity of reports comparing morbidity between HHD and IHD or PD and none in a European population. The aim of this study is to compare morbidity between modalities in a Swedish population. Methods The Swedish Renal Registry was used to retrieve patients starting on HHD, IHD or PD. Patients were matched according to sex, age, comorbidity and start date. The Swedish Inpatient Registry was used to determine comorbidity before starting renal replacement therapy (RRT) and hospital admissions during RRT. Dialysis technique survival was compared between HHD and PD. Results RRT was initiated with HHD for 152 patients; these were matched with 608 patients with IHD and 456 with PD. Patients with HHD had significantly lower median annual admission rate and number of days in hospital. (1.7 admissions; 12 days) compared with IHD (2.2; 14) and PD (2.8; 20). The annual admission rate was significantly lower for patients with HHD compared with IHD for cardiovascular diagnoses and compared with PD for infectious disease diagnoses. Dialysis technique survival was significantly longer with HHD compared with PD. Conclusions Patients choosing HHD as initial RRT spend less time in hospital compared with patients on IHD and PD and they were more likely than PD patients, to remain on their initial modality. These advantages, in combination with better survival and higher likelihood of renal transplantation, are important incentives for promoting the use of HHD.

Coorscreen: A Low-Cost, on-Site Mammography Screening Program

1996 ◽  
Vol 10 (5) ◽  
pp. 364-370 ◽  
Author(s):  
Mary Greenwood ◽  
Joanne Henritze
Keyword(s):  
Breast Cancer ◽  
Early Detection ◽  
Malignant Disease ◽  
Screening Program ◽  
Low Cost ◽  
Cost Savings ◽  
Participation Rate ◽  
Program Cost ◽  
Mammography Screening Program ◽  
Screening And Prevention

Setting. Coors Brewing Company is a self-insured corporation of 10,600 employees located in Golden, Colorado. Management has long believed in the value of a healthy workforce and has instituted ongoing health and wellness programming since 1981. Program design. Coorscreen was started in September 1985 to create an ongoing awareness of breast cancer screening and prevention for all female employees, spouses, and retirees and to lower the health care costs for the company through early detection of breast cancer. Program impact. From 1985 through 1993, 12,210 mammograms were completed on 3729 employees, spouses, and retirees. The participation rate was 83%. Forty-seven malignant conditions were confirmed during the first 8 years. Pathology reports confirmed 43 early detections (10 employees) and four late detections (two employees). The 10 cases of malignant disease detected early among employees cost an average of $12,388 in terms of direct medical costs, short-term disability, temporary replacement, and ongoing benefits. The two cases detected late among employees cost an average of $143,398. Among spouses, cases of malignant disease detected late have cost an average of $69,230 more than cases detected early. On the basis of early detection for 10 employees and 26 spouses, the total savings are estimated to be $3,110,000. Discussion. The Coorscreen program cost savings for the first 8 years were $3,110,080 because of the lower cost of early versus late detection. Total screening and procedural costs to the company have equaled $668,690. Thus the company has realized a total cost savings of $2,441,190.

scholarly journals 750. Serious Bacterial Infections: Successful Outpatient Management by Infectious Disease Physicians in Office Infusion Centers

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S334-S335
Author(s):  
John S Adams ◽  
Brian S Metzger ◽  
Richard M Mandel ◽  
Thomas K Sleweon ◽  
Robin H Dretler ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Clinical Outcomes ◽  
Bacterial Infections ◽  
Clinical Success ◽  
Retrospective Chart Review ◽  
Success Rates ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Cns Infections ◽  
Serious Bacterial Infections ◽  
Unplanned Hospitalizations

Abstract Background Patients with serious bacterial infections (SBI), identified as bone and joint infections (BJI), bacteremia/endocarditis, and central nervous system (CNS) infections are frequently discharged on outpatient parenteral antimicrobial therapy (OPAT). They account for 48% of all infections treated in our network of Infectious Disease (ID) physician office infusion centers (POICs). Care for these patients poses risks and challenges to ensure safe and successful outcomes while avoiding hospitalizations. This study examines clinical outcomes and complications of our SBI patients receiving OPAT in ID POICs. Methods All patients were identified with SBI receiving OPAT in 2017 from 14 POICs. A group of 250 patients were randomly selected by incidence of diagnosis and a retrospective chart review performed. Demographics, treatment regimen, clinical outcomes, adverse drug reactions (ADRs) and unplanned hospitalizations during OPAT were collected. Clinical success was defined as clinical cure or improvement at completion of OPAT. Patients were included who were hospitalized for <7 days and subsequently completed OPAT. ADRs leading to hospitalization or discontinuation of OPAT were deemed serious. Descriptive statistics were used for distribution of variables. Results SBI patients included BJI (n = 175), bacteremia/endocarditis (n = 60) and CNS infections (n = 15) as described in Table 1. Successful clinical outcomes were reported in 224 patients (89.6%) after a mean duration of OPAT of 32±20 days. Of these, 15 patients (6.7%) were hospitalized during OPAT and returned to the POIC for a successful clinical outcome. Clinical success rates for BJI, bacteremia/endocarditis and CNS infections were 89.1%, 91.6% and 86.7%, respectively. The primary reason for nonfavorable outcomes was worsening of infection (15/26, 58%). Serious ADRs were reported in 12 patients (4.8%) with 6 (2.4%) leading to hospitalization. Unplanned hospitalizations during OPAT occurred in 33 patients (13.2%) with the majority (21/33, 64%) related to disease. ADRs and hospitalizations compare favorably to data previously reported. (Schmidt et al. OFID 16.4, 2017). Conclusion Patients with serious bacterial infections had high success rates when treated by an ID physician in infusion centers. Adverse events and unplanned hospitalization rates were low. Disclosures All authors: No reported disclosures.

Safety and feasibility of outpatient high-dose cytarabine (HIDAC) and intermediate-dose cytarabine (IDAC) for consolidation therapy in acute myeloid leukemia (AML).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18509-e18509
Author(s):  
Wenhui Li ◽  
Katherine Simondsen ◽  
Jamie Lee ◽  
Maher Elharake ◽  
Timothy Edward Kubal
Keyword(s):  
Acute Myeloid Leukemia ◽  
Risk Stratification ◽  
Induction Therapy ◽  
Myeloid Leukemia ◽  
Cost Savings ◽  
Outpatient Setting ◽  
High Dose ◽  
Inpatient Setting ◽  
Consolidation Therapy ◽  
Acute Myeloid

e18509 Background: Patients with acute myeloid leukemia (AML) who achieve complete remission with induction therapy require consolidation therapy. The standard of care consolidation is HIDAC or IDAC depending on age and risk stratification. Consolidation therapy has historically been administered in the inpatient setting. The rising cost of AML care has prompted institutions to consider shifting therapy to the outpatient setting. However, the safety and feasibility of outpatient HIDAC/IDAC consolidation therapy has not been established. Moffitt Cancer Center (MCC) developed an Inpatient/Outpatient (IPOP) program to facilitate administration of complicated regimens in the outpatient setting. We hypothesized that IPOP administration of HIDAC/IDAC consolidation therapy is safe and may have cost-savings implications. Methods: We conducted a retrospective chart review on AML patients who were 18 years or older and received HIDAC/IDAC consolidation therapy at MCC following induction therapy from January 1, 2015 to November 1, 2018. Data collected included age, risk stratification, treatment history, clinic visits, number of cycles received in the IPOP versus inpatient setting, supportive care, hospitalizations, and chemotherapy related adverse events. Results: 258 of 270 cycles of HIDAC/IDAC were delivered outpatient over the reviewed time period to 122 patients. 45 patients (37%) required hospitalization during consolidation with the primary reason being neutropenic fever (72%), consistent with historical data (50 to 90%). No patients receiving outpatient consolidation required hospitalization during chemotherapy. Specific details regarding administration of HIDAC/IDAC in IPOP, including infusion times, frequency of visits, laboratory frequency, supportive medications, and home antimicrobials will be reported. 1,290 hospital days were saved through IPOP administration. Financial assessment of cost-savings is being determined and will be reported. Conclusions: Outpatient administration of HIDAC/IDAC consolidation therapy for AML is a safe option for AML patients undergoing consolidation.

Kentucky’s Smoking Cessation Quitline: Annual Estimated Return on Investment to Employers

2018 ◽  
Vol 33 (2) ◽  
pp. 285-288
Author(s):  
Nathan Pauly ◽  
Jeffrey Talbert ◽  
Shannon Parsley ◽  
Bobbye Gray ◽  
Ellen J. Hahn
Keyword(s):  
Smoking Cessation ◽  
Return On Investment ◽  
Tobacco Cessation ◽  
Meta Analysis ◽  
Cost Savings ◽  
Study Objective ◽  
Program Cost ◽  
Study Results ◽  
Support Cost

Purpose: State-based smoking cessation telephone quitlines offer a cost-effective method of providing tobacco treatment at no cost to participants. The study objective was to assess the annual return on investment (ROI) to employers if they were to bear the entire responsibility from the Kentucky quitline. Design: A retrospective design was used to estimate the annual ROI to employers from the Kentucky quitline. Setting: The telephone quitline (1-800-QUIT-NOW) provided intake and follow-up data for all Kentucky participants who enrolled in the program from 2012 to 2014. Participants: All individuals aged 18+ who enrolled in the Kentucky quitline from 2012 to 2014. Measures: Successful tobacco cessation was assessed from follow-up surveys that took place after individuals completed the program. Cost savings to employers associated with tobacco cessation were gleaned from a published meta-analysis. The Kentucky quitline provided estimates for annual program expenses. Analysis: The annual ROI was calculated as the difference between estimated annual cost savings due to smoking cessation and annual program expenses. Results: From 2012 to 2014, 5425 individuals were enrolled in the quitline. The annual ROI to employers was estimated to be $998 680, with an ROI ratio of 6.2:1. Conclusions: Employers may receive a substantial ROI if they were to fund the Kentucky quitline. Study results may be used as evidence to support cost-sharing partnerships between public health agencies and employers to sustain funding for telephone quitlines.

scholarly journals 116. Leveraging the Use of the PCR-based Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Swab in the Emergency Department to Optimize Vancomycin Use in the Inpatient Setting

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S72-S72
Author(s):  
Dayna McManus ◽  
Jeffrey E Topal ◽  
Hagar Kassab
Keyword(s):  
Primary Endpoint ◽  
Nasal Swab ◽  
Secondary Endpoint ◽  
Inpatient Setting ◽  
New Haven ◽  
Inclusion Criteria ◽  
Post Intervention ◽  
Days Of Therapy ◽  
Before And After ◽  
The Impact

Abstract Background The MRSA nasal swab has been shown to have a negative predictive value of 97–100% for an MRSA infection. Therefore, a negative MRSA swab can be an important antimicrobial stewardship tool to stop unnecessary empiric anti-MRSA therapy. Prolonged anti-MRSA therapy may increase hospital length stay, adverse effects, antimicrobial resistance, and increase the risk of acute kidney injury. Timely obtainment of the MRSA nasal swab is paramount to prevent these complications. To improve the timely collection at our institution, we linked the MRSA nasal swab order with the initial order for vancomycin in the ED using the electronic medical record. Methods This was a single-center, retrospective review of adult ED patients (≥ 18 years) who recieved vancomycin at Yale New Haven Hospital, New Haven, CT, USA and had an MRSA nasal swab collected. The pre-intervention cohort were patients who met inclusion criteria between September 2018 and October 2018. The post-intervention cohort, following the linking of the MRSA nasal swab with the vancomycin order included patients between June 2019 and July 2019. The primary endpoint was the time from the ED visit to vancomycin discontinuation in patients with a negative MRSA nasal swab. The secondary endpoint was a comparison of inpatient vancomycin usage before and after implimentation of the intervention. Results In the pre-intervention cohort 665 patients were reviewed with 100 meeting inclusion criteria and in the post-intervention cohort 242 patients were reviewed with 100 meeting inclusion criteria. Baseline demographic characteristics were similar between the two cohorts. For the primary endpoint, the time from ED visit until vancomycin discontinuation was 61 hours in the pre-intervention cohort versus 34 hours in the post-intervention cohort (p&lt; 0.001). The secondary endpoint of the impact of the intervention on vancomycin usage is depicted figure attached. Vancomycin IV Days of Therapy/1000 Patient Days Before and After Intervention Conclusion Linking the MRSA nasal swab order with the order for vancomycin in the ED led to a significantly shorter time of empiric vancomycin which in turn resulted in an overall reduction in the use of vancomycin. Disclosures All Authors: No reported disclosures

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