Decreased hospital readmissions after programmatic strengthening of an outpatient parenteral antimicrobial therapy (OPAT) program

Abstract

Objective: To determine whether a structured OPAT program supervised by an infectious disease physician and led by an OPAT nurse decreased hospital readmission rates and OPAT-related complications and whether it affected clinical cure. We also evaluated predictors of readmission while receiving OPAT. Patients: A convenience sample of 428 patients admitted to a tertiary-care hospital in Chicago, Illinois, with infections requiring intravenous antibiotic therapy after hospital discharge. Methods: In this retrospective, quasi-experimental study, we compared patients discharged on intravenous antimicrobials from an OPAT program before and after implementation of a structured ID physician and nurse-led OPAT program. The preintervention group consisted of patients discharged on OPAT managed by individual physicians without central program oversight or nurse care coordination. All-cause and OPAT-related readmissions were compared using the χ2 test. Factors associated with readmission for OPAT-related problems at a significance level of P < .10 in univariate analysis were eligible for testing in a forward, stepwise, multinomial, logistic regression to identify independent predictors of readmission. Results: In total, 428 patients were included in the study. Unplanned OPAT-related hospital readmissions decreased significantly after implementation of the structured OPAT program (17.8% vs 7%; P = .003). OPAT-related readmission reasons included infection recurrence or progression (53%), adverse drug reaction (26%), or line-associated issues (21%). Independent predictors of hospital readmission due to OPAT-related events included vancomycin administration and longer length of outpatient therapy. Clinical cure increased from 69.8% before the intervention to 94.9% after the intervention (P < .001). Conclusion: A structured ID physician and nurse-led OPAT program was associated with a decrease in OPAT-related readmissions and improved clinical cure.

Identifying the potential impact of a multidisciplinary outpatient antimicrobial therapy program in an area of high social vulnerability

“…Investigators at an urban academic center also reported readmissions due to disease worsening or progression as well as line-associated issues prior to the implementation of an OPAT program and saw a significant reduction in the readmission rates following the integration of a structured OPAT program. 7,12 Also, patients residing in highly vulnerable areas are at an increased risk for complications following hospital discharge leading to rehospitalization, which is consistent with the results presented in our study. 17 journals.sagepub.com/home/tai…”

“…5,6 The involvement of a multidisciplinary ID team in an established OPAT program has been shown to reduce antimicrobial prescribing errors. 7 Through collaboration with home health services, the dedicated OPAT/COpAT program can enhance the continuity of care by optimizing the duration of antimicrobial therapy pre-discharge and improving safety monitoring by receiving and responding to critical laboratory results postdischarge. Nonetheless, there is limited data that describes the utility of pre-and post-discharge OPAT/COpAT programs in optimizing patient care, particularly in socially vulnerable communities where inequities in healthcare access have detrimental outcomes.…”

Improving Antimicrobial Treatment in Terms of Antimicrobial Stewardship and Health Costs by an Opat Service a Single Centre Prospective Cohort Study

“…With the introduction of the OPAT service, a prospective data collection was started thus facilitating the assessment of clinical response to antimicrobial treatment and monitoring of adverse events related to devices and antibiotic use. Moreover, our approach with the integration of ID consultation service, OPAT and stewardship could be a role model towards the implementation of other OPAT services, emphasizing also the mandatory interprofessional approach including ID experts, nurses as well as clinical pharmacists [27,28]. Our study has limitations.…”

Outpatient Parenteral Antimicrobial Therapy in a Safety Net Hospital: Opportunities for Improvement

“…As health care continues to move toward more cost-conscious, value-based care, our experience supports the need for appropriate infrastructure and resources to achieve these goals. OPAT can reduce length of stay, readmissions, and ED visits [ 2 , 3 , 12 ], although recent data demonstrate the need for appropriate infrastructure and an expert multidisciplinary team to best support state-of-the-art practice [ 26 ]. Furthermore, OPAT may be a model for fee-for-value compensation, especially with care moving into ambulatory and nontraditional settings [ 27 , 28 ].…”

“…Its numerous benefits include improved patient quality of life over inpatient care and hospital cost savings [ 1 ]. OPAT programs decrease health care utilization by lowering the number of inpatient days, emergency department (ED) visits, and hospital readmissions [ 2 , 3 ]. Increases in ED visits and hospital readmissions further strain ED and hospital resources, which can be financially burdensome to the health care system [ 1 ].…”