Propensity Score-Weighted Analysis of the Impact of Outpatient Parenteral Antimicrobial Therapy Plan Reconciliation on Unscheduled Care.

BACKGROUND

Outpatient parenteral antimicrobial therapy (OPAT) is a mechanism for delivery of antimicrobial therapy outside of inpatient care; however, risks associated with OPAT combined with transition-of-care vulnerabilities may result in unscheduled healthcare use. On 15 June 2020, our institution launched a program entailing OPAT plan review and reconciliation by infectious diseases (ID) pharmacists prior to hospital discharge. We analyzed the frequency of all-cause 90-day emergency department (ED) visits, readmissions, and mortality of patients pre- and postimplementation of OPAT plan reconciliation.

METHODS

Unique, adult OPAT recipients discharged to home or a postacute care facility from an academic hospital before (1 June 2017-14 June 2020) and after (15 June 2020-30 June 2022) implementation of ID pharmacist review and reconciliation of OPAT plans were included. We performed a propensity score-weighted analysis to compare 90-day outcomes pre- and postintervention while adjusting for relevant clinical characteristics. We accounted for missing data by using multiple imputation.

RESULTS

A total of 2408 OPAT patients met inclusion criteria: 1650 preimplementation and 758 postimplementation. Patients in the postimplementation group had statistically fewer ED visits (pre: 22.2%; post: 17.8%; = .02) and hospital readmissions (pre: 38.9%; post: 33.4%; = .01) within 90 days after discharge from index admission when compared to the preimplementation cohort. There was no significant difference in the 90-day all-cause mortality between cohorts.

CONCLUSIONS

Following implementation of OPAT plan reconciliation by ID pharmacists prior to discharge from acute care, OPAT recipients were significantly less likely to experience 90-day ED visits or 90-day readmissions.