Abstract 15606: The Association Between Health System Integration and Quality and Outcomes After Acute Myocardial Infarction

Introduction: Integrated care has long been put forward as a way to both decrease costs and improve the quality and outcomes. To date however, this hypothesis has not been formally evaluated in nationally representative data. In this study, using 100% Medicare data and a novel enhanced database (EDB), we aim to determine the association between integrated inpatient and outpatient care after acute myocardial infarction (AMI) and quality and outcomes. Hypothesis: There will be no difference in quality or outcomes after AMI between integrated and non-integrated inpatient and outpatient care. Methods: Using 100% Medicare data and a novel EDB that combines claims data, tax and financial records and proprietary datasets, we classified all hospitals and providers in the US as: “part of a health system” or “not part of a health system.” We then determined whether AMI patients had “integrated” (hospital and outpatient provider in the same system) or “non-integrated” (hospital and outpatient provider not in the same system) care after AMI. Multivariable linear regression was used to determine the association between care integration between hospital and outpatient provider and quality/outcomes. Results: The differences in quality and outcomes, based on care integration, are displayed below ( Table ). There were no differences in short-term quality or follow up. Integrated care was associated with significantly higher rates of cardiac rehab enrollment. Long-term quality metric performance and outcomes were uniformly better among patients who received integrated care. Conclusions: Integrated inpatient and outpatient care after AMI is associated with higher rates of cardiac rehab enrollment, better long-term quality and improved patient outcomes.

1301. Evaluation of the Rates of HIV Post-Exposure Prophylaxis Completion After the Implementation of an Automated Referral System in the Emergency Department

Background A 28-day regimen of Post-Exposure Prophylaxis (PEP) administered within 72 hour significantly reduces HIV infection, for both occupational and nonoccupational exposures (NOE); however, adherence to PEP for NOE has been reported to have poor rates of completion.1 To optimize PEP referrals from our ED to our clinics, we implemented an automated referral system to maximize PEP completion and link patients to outpatient care and HIV pre-exposure prophylaxis (PrEP), if appropriate. Methods In our ED, PEP patients receive a starter kit from an automated medication dispensing system. Starting in March 2017, a daily automated report of patients who received a starter kit in the ED was generated and emailed to patient navigators who would contact patients and offer follow-up appointments. Our main objective was to describe the rate of outpatient follow-up of patients initiated on PEP for NOE from March 2017 to March 2018, as well as patient demographics and linkage to PrEP. Results Out of 128 patients seen in the ED for PEP, 30% (38) were for NOE. Of these, 68% were female, with a median age of 27 years old (range: 14–59). Nearly half had no insurance (45%). The majority (84%) reported sexual intercourse or sexual assault as the exposure. Most patients were contacted for follow-up (76%) and half (48%) had a follow-up appointment. Patients who presented to the ED >24 hours after exposure were less likely to complete a follow-up (35% vs. 75%, P = 0.035), as were uninsured patients (24% vs. 57%, P = 0.052). From 38 patients, 13 (34%) qualified for PrEP, eight (62%) followed as outpatients and one (8%) was started on PrEP. Conclusion The automated system ensured that half our PEP patients were seen by an outpatient provider, increasing their likelihood of finishing the 28 days of PEP. Patients presenting late to the ED and uninsured patients were less likely to follow-up. Further research is needed to identify interventions to improve follow-up. Finally, transition to PrEP was low and additional interventions should be explored to improve this process. Reference 1. Kahn JO, Martin JN, Roland ME, et al. Feasibility of postexposure prophylaxis (PEP) against human immunodeficiency virus infection after sexual or injection drug use exposure: the San Francisco PEP Study. J Infect Dis 183(5):707–714. Disclosures All authors: No reported disclosures.