New Outpatient Antibiotic Therapy Program Cut Hospital Readmission Rates in Half

In a new study conducted in a healthcare system in the Bronx, a team of healthcare providers has created a new program to cut hospital readmission rates in patients receiving outpatient IV antibiotic treatment.

Infection-related hospital readmission is a risk for patients who are receiving outpatient care with intravenous (IV) antibiotic treatment. However, recently, a team of healthcare providers developed a treatment program that succeeded in cutting readmission rates for this population in half.

Outpatient parenteral antibiotic therapy (OPAT) allows healthcare providers to administer IV antibiotics to patients to treat a wide range of infections in the patient’s home environment, an office, or clinic. With the development of OPAT programs, healthcare providers can continue to safely give their patients infection treatment while reducing healthcare costs and the length of hospital stays. However, patients receiving OPAT care commonly experience complications, antibiotic-related adverse events, and treatment failure resulting in hospital readmission.

In order to address the problem of higher readmission rates, emergency department visits, and mortality in patients receiving outpatient IV treatment, a healthcare team serving patients in the Bronx borough of New York City, developed a new OPAT program.

The new study, recently published in the journal Open Forum Infectious Diseases, details the implementation and results of The Transition-of-Care Outpatient Parenteral Antibiotic Therapy (TOC-OPAT) developed by a healthcare team in The Montefiore Health System. The study authors note that their healthcare system serves the poorest borough in New York City and the least healthy county in New York State, where more than 30% of residents live below the poverty level and a high percentage are on Medicaid. Due to crowded living conditions, lack of commercial insurance, and complex chronic infections, OPAT patients in certain populations can experience 30-day hospital readmission rates of up to 50%.

With a team of physicians, homecare agencies, nursing facilities, and a bilingual nurse coordinator, the study group developed the TOC-OPAT program to streamline communication and care. “This was really borne out of our own observations,” said Theresa Madaline, MD, clinical director of Infectious Diseases Services at Montefiore and a lead author of the study, in a recent interview with Contagion®. Dr. Madaline notes that some of the common infections that her patients receiving OPAT care often get include diabetes-related foot infections, infected joint replacements, obstetrical complications, and skin infections. “We noticed that these patients would go home with the IV antibiotics, and then we’d see them again a couple of weeks later in the hospital with some sort of complication or their infection didn’t get better.”

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.”