OBJECTIVES:

Outpatient parenteral antimicrobial therapy (OPAT) is a treatment model to provide intravenous antimicrobials for medically stable patients after hospital discharge. Our OPAT program was enhanced through the addition of a nurse specialist who provides services including treatment coordination, disease monitoring, and care communication (post-intervention group). This study aims to quantify 30 and 60-day OPAT program-related readmission rates and associated costs between pre- and post-intervention programs at an academic healthcare system from a payer’s perspective.

METHODS:

Patients who received OPAT for at least two days were included in the analysis. Baseline characteristics were compared pre- and post-intervention. We used multivariate logistic regression to estimate readmission odds ratio. A zero-inflated negative binomial model was used to evaluate the association between the type of OPAT program and the cost associated with unplanned OPAT-related readmissions. Margins estimation was then applied to predict the adjusted overall OPAT-related readmission costs. This approach computes average costs in both programs using model prediction equations.

RESULTS:

428 eligible patients were included, with 73 from the pre-intervention group and 355 from the post-intervention group. After adjusting for the use of vancomycin, we found the post-intervention OPAT program was not associated with 30-day readmission (OR 0.52; 95% CI: 0.22-1.05, P-value: 0.067) and was associated with a decrease in 60-day readmission (OR 0.58; 95% CI: 0.19-0.91, P-value: 0.028) compared to the pre-intervention program. The predicted average total costs from OPAT hospitalization were $5,685 per person for the pre-intervention program and $2,201 per person for the post-intervention program, with a 61.3% reduction, after adjusting for age and intensive care unit visit during index hospitalization.

CONCLUSIONS:

The nurse-coordinated OPAT program was associated with lower OPAT-related 60-day readmission rates and costs.