The study included 146 patients enrolled in the TOC-OPAT program from July 2015 to February 2016 and a control group receiving the previous standard of care from January 2015 to June 2015. Both groups included patients aged 18 years and older who were discharged from the hospital to either their home or a nursing facility following infectious disease consultation with IV antibiotics. Patients in the TOC-OPAT team received a new “bundle” of care offerings, including an evaluation by a multidisciplinary team and educational materials before hospital discharge, which covered topics such as IV-line maintenance and the risks and benefits of antibiotic therapy. Throughout their care, patients had the cell phone number of the nurse coordinator, whom they could contact throughout the day if they had any issues or questions, while also receiving additional support from OPAT physicians.
At the end of the study, the researchers found that the TOC-OPAT patients had a 30-day hospital readmission rate of 13% versus the 26.1% rate seen in the control group. While the rate of emergency department visits was similar, and mortality remained low in both groups, the team estimated that the TOC-OPAT program could help prevent 97 readmissions each per year, resulting in the hospital saving between $834,200 and $1,522,900 per year. Speaking to what made the program work, nurse coordinator Riganni Urrely noted that the TOC-OPAT program featured improved communication with patients, along with bilingual personnel who were key to serving a largely Spanish-speaking populace. “I think the most effective element is having the lab work processed in real time,” said Urrely of the program’s use of increased laboratory monitoring for infections. “It’s super important to catch things before they exacerbate into something worse. We’re able to catch something before it puts these patients in a situation where they have to be readmitted.”
With the results of their new program’s study, the team at Montefiore hope to continue offering improved OPAT care for patients while offering lessons for other healthcare networks around the country. “Our biggest takeaway is that we have a very high-risk population at baseline. These are folks who are often low income, they often have a lot of social stressors and additional things in their life which make having to be on intravenous antibiotics at home tremendously burdensome,” says Dr. Madaline, who called the TOC-OPAT program a game changer for patients. “If we’re able to do this at our institution, with our patient population, with very little in the way of financial resources, this is a sustainable model for any population in the United States.”
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