20 Table 1. Characterisitcs of Patients Discharged to a Long-Term Care Facilities (n=6,701) Total Variable


Age <65 y


65–75 y 76–85 y ≥86 y


Male Marital status, single


Primary admission diagnosis (MS-DRG) Surgery/Procedure Infection-related


Medical Infection-related Charlson comorbidity index; median (IQR)


Comorbidities Cerebrovascular disease Diabetes


Chronic obstructive pulmonary disease Cancer


Heart failure Renal disease Liver disease


Length of stay, d, median (IQR)


Received antibiotics anytime during index admission


Received antibiotics within the first 24 h of index admission


(n=6,701) No. (%)


2,415 (36.0) 2,068 (30.9) 1,433 (21.4) 785 (11.7)


3,328 (49.7) 4,039 (60.3)


4,289 (64.0) 318 (7.4)


2,412 (36.0) 458 (19.0) 3 (1–5)


2,281 (34.0) 2,198 (32.8) 2,159 (32.2) 1,971 (29.4) 1,551 (23.2) 1,371 (20.5) 414 (6.2)


7 (4–12) 4,343 (64.8) 3,153 (47.1)


Patients With an Outpatient Antibiotic Prescription (n=1,532) No. (%)


622 (40.6) 441 (28.8) 296 (19.3) 173 (11.3) 753 (49.2) 922 (60.2)


847 (55.3) 124 (14.6) 685 (44.7) 290 (42.3) 4 (2–6)


465 (30.4) 573 (37.4) 537 (35.1) 498 (32.5) 427 (27.9) 363 (23.7) 153 (10.0) 8 (5–14)


1,517 (99.0) 1,099 (71.7) Note. SD, standard deviation; MS-DRG; Medicare severity diagnosis-related group; IQR, interquartile range.


diagnosis code for a C. difficile infection (CDI). An additional 76 patient records (5.0%) lacked a diagnosis code for a bacterial infection and were identified using a positive clinical culture for a bacterial organism or a positive C. difficile toxin assay or PCR test. Among these discharges, 45 of 76 (59.2%) had a positive urine culture indicating a possible UTI, and 25 of 76 (32.9%) had positive cultures indicating a possible skin or soft-tissue infection. Last, 198 patients discharged (12.9%) who received an antibiotic upon discharge to an LTCF had a medical record with neither a diagnosis code for a bacterial infection nor a positive culture during the index admission. In a 20% random sample (n=38) of these discharges, the most prevalent documented indications on patient discharge summaries for receiving antibiotics were pro- phylaxis (34.2%) and aspiration pneumonia (10.5%). Among all discharges to an LTCF, the incidence of read- mission to OHSU Hospital within 30 days of discharge was 957 of


6,701 (14.3%), of whom 350 patients (36.6%) were readmitted within 7 days and 101 patients (10.6%) were readmitted within 2 days. In addition, the incidence of an emergency department (ED) visit within 30 days of discharge was 9.1%, and 1.0% of patients had a C. difficile–positive PCR test or toxin assay during a readmission or ED visit within 60 days of discharge. The inci- dence of 30-day hospital readmission was significantly higher among patients who received an antibiotic upon discharge com- pared to patients who did not receive an antibiotic upon discharge to an LTCF (15.9% vs 13.8%; P=.03). Similarly, patients who received an antibiotic prescription upon discharge were sig- nificantly more likely to visit the ED within 30 days compared to patients who did not receive an antibiotic upon discharge to an LTCF (11.0% vs 8.6%; P=.003). The incidence of C. difficile- positive PCR test or toxin assay during a readmission or ED visit within 60 days of discharge was 1.6% among patients who


Patients Without an Outpatient Antibiotic Prescription (n=5,169) No. (%)


1,793 (34.7) 1,627 (31.5) 1,137 (22.0) 612 (11.8)


2,575 (49.8) 3,117 (60.3)


3,442 (66.6) 194 (5.6)


1,727 (33.4) 168 (9.7) 3 (1–5)


1,816 (35.1) 1,625 (31.4) 1,622 (31.4) 1,476 (28.5) 1,124 (21.8) 1,008 (19.5) 261 (5.1)


7 (4–11) 2,826 (54.7) 2,054 (39.7)


Bo R. Weber et al


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