OPAT patient review with infectious diseases specialty intervention

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Among privately insured individuals below age 65, ID consultation during OPAT is associated with large and significant reductions in the rate of ED admission and hospital admission in the 30 days after an index event, as well as lower total healthcare spending” Shah et al (2018).

Abstract:

BACKGROUND: Outpatient parenteral antimicrobial therapy (OPAT) can be managed by specialists in infectious disease (ID) or by other physicians. Better management of OPAT can reduce the likelihood of readmission or emergency department (ED) use. The relative success of ID specialists and other physicians in managing OPAT has received little study.

METHODS: We analyzed a national database of insurance claims for privately insured individuals under age 65, locating inpatient acute-care stays in 2013 and 2014 that were followed by OPAT. Through propensity scoring, patients who received outpatient ID intervention (ID-led OPAT) were matched one-to-one with those who did not (Other OPAT). We estimated regression models of hospital and ED admission, and total healthcare payments, over the first 30 days after discharge.

RESULTS: The final analytic sample of 8,200 observations was well balanced on clinical and demographic characteristics. Soft-tissue infection and osteomyelitis were the most common infections in the index event, each affecting more than 40% of individuals. Relative to those with Other OPAT, people with ID-led OPAT had lower odds of ED admission (OR 0.449, 95% confidence interval [CI] 0.311 – 0.645) or hospitalization (OR 0.661, 95% CI 0.557 – 0.791) over 30 days, and they accumulated $1,488 less in total healthcare payments (95% CI -2,2,688.56 – -266.58).

CONCLUSIONS: Among privately insured individuals below age 65, ID consultation during OPAT is associated with large and significant reductions in the rate of ED admission and hospital admission in the 30 days after an index event, as well as lower total healthcare spending.

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Reference:

Shah, A., Petrak, R., Fliegelman, R., Shrestha, N., Allison, G., Zurlo, J., Parker, S., Poretz, D., McKinsey, D., Dougherty, M., Martinelli, L., Mathur, A., Rodriguez, A. and Smith, M.W. (2018) Infectious Diseases Specialty Intervention is Associated with Better Outcomes among Privately Insured Individuals Receiving Outpatient Parenteral Antimicrobial Therapy. Clinical Infectious Diseases. September 21st. .

doi: 10.1093/cid/ciy674.

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