Prediction of risk of unplanned hospitalisation in outpatient parenteral antimicrobial therapy

What is it about?

We developed and internally validated a statistical model for the prediction of the risk of 30-day unplanned hospitalization in patients receiving outpatient parenteral antimicrobial therapy (OPAT). To develop the model we analyzed data from 1324 episodes of OPAT at Sheffield Teaching Hospitals, South Yorkshire, England, over a period of 2 years. Using robust statistical methodology, we identified a set of six important predictors of unplanned hospitalization based on readily available data. The model consisted of age, Charlson co-morbidity score, prior hospitalizations in the past 12 months, concurrent intravenous antimicrobial therapy, endovascular infection and mode of OPAT treatment. Using various methods for model assessment, we found that our model predicted accurately the probability of unplanned hospitalization in OPAT patients and exhibited good calibration and concordance abilities in bootstrap validation. Thereby, our model has the potential to inform evidence-based interventions and personalized care and support to prevent hospital readmissions.

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Why is it important?

This study adds to existing literature by showing that patients receiving OPAT are at risk of unplanned hospitalizations, some of which may be preventable. Averting unnecessary hospitalization depends on understanding which patients are likely to be readmitted. The predictive model for 30-day unplanned hospitalization developed in this study is based on six easily obtainable variables and has adequate prediction metrics. This model has the potential to identify high-risk patients upon presentation to the OPAT service at a large tertiary referral teaching hospital, thereby informing evidence-based interventions, and personalized care and support to prevent hospital readmissions. Further research is required to assess how this model may perform in different settings, and to elucidate how it may be incorporated into clinical practice to improve the care of patients receiving OPAT.