Outpatient Parenteral Antimicrobial Therapy (OPAT) Treatment Center as Part of Integrated Care Delivery – Single-Center Experience from the First Three Years of Operation
To describe and evaluate the clinical experience of delivering outpatient antimicrobial therapy (OPAT) at the St. Vincent Outpatient Treatment Center (OTC) which, in partnership with Infectious Disease of Indiana, offers a unique model in its integrated care delivery, staffing, and monitoring practices.
A retrospective cohort from the first 3 years of OTC operation (Jan 2010 – Dec 2012) was assessed to describe patient characteristics, clinical characteristics, and outcome of hospital admission during OPAT treatment. The sample included those treated with antibiotics most frequently used by patients seen in the OTC - ceftriaxone, daptomycin, or ertapenem. Those on other antimicrobial therapy were excluded.
Of 2,684 OPAT patients, 51% were male and the cohort had a mean age of 52 years. Most patients had commercial insurance (57%), followed by Medicare (29%), self-pay (9%), and Medicaid (4%). Patients were either diverted to OPAT from hospitalization (N=1735, 65%) or initiated on OPAT, avoiding hospitalization (N=949, 35%). The two groups differed modestly, most notably in age with means of 51 for OPAT post-hospital and 54 for OPAT only (p < 0.001). OPAT was delivered at the OTC (57%), self-administered (33%), or at an external site (9%). Antibiotic use was 39% daptomycin, 35% ertapenem, and 26% ceftriaxone. Diagnoses for which OPAT was prescribed included skin and soft tissue (50%); bone and joint (17%); intra-abdominal (7%); genitourinary (7%); sepsis, pulmonary/respiratory, device-related, endovascular, ear-nose-throat or other infection (5% or less each). Overall, there were 81 hospital admissions from OPAT (3.1%). Admissions were similar for both OPAT post-hospital and only groups (3.3% vs. 2.5%, p=0.24) and ranged from 1.6% for genitourinary to 11.1% for endovascular diagnoses. The average treatment duration, including any intervening hospitalization was 17 days, 17.5 and 15.8 days for the post-hospital and OPAT only groups respectively.
Once daily IV antibiotics are the most common therapies in this OPAT model. The unique model at the St. Vincent OTC demonstrates a type of care integration that potentially diverts patients to OPAT in order to reduce the number and length of hospitalizations required by patients.
Merck & Co., Inc.: Investigator, Research support
D. Elizondo, None
J. Lock, None
S. Marcella, Merck & Co., Inc.: Employee, Salary
Y. Xie, Merck & Co.: Employee, Salary