In the JournalsPerspective

Early follow-up associated with lower risk for readmission in OPAT patients

John J. Zurlo, MD
John J. Zurlo

Among patients receiving outpatient parenteral antibiotic therapy, or OPAT, follow-up with an infectious disease physician within 2 weeks was associated with a lower risk for all-cause 30-day readmission, according to results from a pair-matched case-control study.

John J. Zurlo, MD, director of the division of infectious diseases at Thomas Jefferson University in Philadelphia, and colleagues said studies have shown that rates of of 30-day readmission often exceed 20% in OPAT patients.

“Prior guidelines for managing patients on OPAT suggested weekly follow-up. Yet that recommendation was based on expert opinion rather than hard data. Moreover, in practice, this recommendation was unlikely to be adhered to,” Zurlo told Infectious Disease News. “Our study was the first to show that early follow-up positively impacts an important outcome measure, that is 30-day readmission.”

For the study, Zurlo and colleagues included 1,102 patients enrolled in the OPAT program at Thomas Jefferson University between January 2012 and December 2014.

According to the findings, readmission within 30 days of discharge occurred for 18% of patients. Of the readmissions, almost 40% occurred within 7 days after discharge, and 46% of the patients were readmitted because of OPAT-related reasons. The most common reason for OPAT-related readmission was worsening or complication of the initial infection, according to Zurlo and colleagues.

An analysis showed a higher risk for readmission among patients with immunosuppression compared with nonsuppressed patients, the researchers reported. They said 30-day readmission appeared to be related to antimicrobial use, with patients receiving fluoroquinolones, metronidazole, antifungals or three or more antimicrobials experiencing higher risks for readmission. Conversely, Ceftriaxone use was associated with a lower risk for readmission, according to the study.

Zurlo and colleagues calculated that an ID follow-up within 2 weeks of discharge resulted in a significantly lower risk for 30-day readmission (adjusted OR = 0.33; 95% CI, 0.19-0.59) than if the patients were followed-up after 2 weeks or not at all.

“While our findings need to be validated by prospective study, we and others who manage OPAT patients should make a concerted effort to closely follow patients during the first 2 weeks following hospital discharge in order to detect the earliest signs of treatment failure or adverse reactions to the antibiotic(s) being administered,” Zurlo said. – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

John J. Zurlo, MD
John J. Zurlo

Among patients receiving outpatient parenteral antibiotic therapy, or OPAT, follow-up with an infectious disease physician within 2 weeks was associated with a lower risk for all-cause 30-day readmission, according to results from a pair-matched case-control study.

John J. Zurlo, MD, director of the division of infectious diseases at Thomas Jefferson University in Philadelphia, and colleagues said studies have shown that rates of of 30-day readmission often exceed 20% in OPAT patients.

“Prior guidelines for managing patients on OPAT suggested weekly follow-up. Yet that recommendation was based on expert opinion rather than hard data. Moreover, in practice, this recommendation was unlikely to be adhered to,” Zurlo told Infectious Disease News. “Our study was the first to show that early follow-up positively impacts an important outcome measure, that is 30-day readmission.”

For the study, Zurlo and colleagues included 1,102 patients enrolled in the OPAT program at Thomas Jefferson University between January 2012 and December 2014.

According to the findings, readmission within 30 days of discharge occurred for 18% of patients. Of the readmissions, almost 40% occurred within 7 days after discharge, and 46% of the patients were readmitted because of OPAT-related reasons. The most common reason for OPAT-related readmission was worsening or complication of the initial infection, according to Zurlo and colleagues.

An analysis showed a higher risk for readmission among patients with immunosuppression compared with nonsuppressed patients, the researchers reported. They said 30-day readmission appeared to be related to antimicrobial use, with patients receiving fluoroquinolones, metronidazole, antifungals or three or more antimicrobials experiencing higher risks for readmission. Conversely, Ceftriaxone use was associated with a lower risk for readmission, according to the study.

Zurlo and colleagues calculated that an ID follow-up within 2 weeks of discharge resulted in a significantly lower risk for 30-day readmission (adjusted OR = 0.33; 95% CI, 0.19-0.59) than if the patients were followed-up after 2 weeks or not at all.

“While our findings need to be validated by prospective study, we and others who manage OPAT patients should make a concerted effort to closely follow patients during the first 2 weeks following hospital discharge in order to detect the earliest signs of treatment failure or adverse reactions to the antibiotic(s) being administered,” Zurlo said. – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

    Perspective

    Federico Palacio Bedoya, MD

    OPAT has been used for more than 40 years, with multiple studies demonstrating its efficacy and safety. OPAT is now used to treat a variety of infections. However, it has been challenging for evidence-based clinical practice to keep up with increasingly frequent use, advances in infusion devices and antibiotics.

    OPAT, regardless of where it occurs, is complex, requires a multidisciplinary team and carries an inherent risk associated with outpatient management of serious infections that may lead to hospital readmissions. Previous studies suggested the concept of an “OPAT bundle” that incorporated multiple steps that include proper selection of patients, ID involvement, patient education, care transition, careful outpatient monitoring and quality management.

    Infectious Diseases Society of America OPAT guidelines published in 2004 recommended weekly outpatient follow-up for all patients receiving OPAT based on expert opinion. The 2018 IDSA OPAT guidelines do not have a generalized recommendation on frequency of outpatient follow-up for patients on OPAT because of limited evidence. Zurlo and colleagues demonstrated that ID follow-up within 2 weeks from discharge was associated with lower 30-day all-cause readmission. As an OPAT physician, these results confirm my current practice and provide evidence to inform the guidelines and inclusion of this element in the OPAT bundle. Some questions remain: Is any health care follow-up associated with decreased readmissions, or is it particularly ID follow up? What are the interventions during that ID follow-up visit that are associated with the decreased readmissions? Can this be implemented using telemedicine, or does this require an in-person visit?

    Overall, this study confirms the importance of continuity of care in improving patient safety and reducing adverse outcomes.

     

     

    Disclosure: 

    • Federico Palacio Bedoya, MD
    • Assistant professor of medicine Division of infectious diseases Emory University School of Medicine OPAT clinic director Emory Healthcare Network

    Disclosures: Palacio Bedoya reports no relevant financial disclosures.