1278. Utilizing a Modified Care Coordination Measurement Tool  to Capture Value for a Pediatric Outpatient Parenteral Antibiotic Therapy (OPAT) program
Session: Oral Abstract Session: Pediatric Antimicrobial Stewardship
Friday, October 9, 2015: 3:15 PM
Room: 5--AB
Background: Caring for children discharged on IV or prolonged oral antibiotics to treat serious infections may require non-reimbursable care coordination (CC) activities. These includes laboratory and antibiotic management, addressing complications, and communicating with clinical care teams, home care companies, and families.  Our objective was to measure the resources needed and capture value added by pediatric infectious diseases involvement at our institution for patient and system level outcomes.

Methods: We used a qualitative feasibility pilot design and modified the Boston Children’s Care Coordination Measurement Tool (CCMT) for OPAT purposes.  We captured every non-reimbursable care coordination activity by the OPAT physician and nurse practitioner and associated outcomes from March 1-April 30, 2015.  We generated summary statistics for this IRB waiver granted QI project.

Results: During this time period, there were 154 separate encounters for 29 patients ages 17 months to 15 years.  Infections treated included neurosurgical complications, endocarditis, osteomyelitis, and others. Total time spent on CC for these 29 patients was 2170 min (low estimate) to 3169 minutes (high estimate).  Five patients with complex social issues comprised 37% of CC time.  All but 7 encounters were clinically focused, with the majority focusing on medical management (31%), advice for families (15%), and management of outpatient labs (17%).  The majority of CC happened by phone communication.  Of 129 phone events, 38% involved direct contact with families, 13% with pharmacies and 11% with home care companies.  Care coordination for OPAT prevented 15 ER visits and hospitalizations.  16 additional subspecialist and 13 primary care visits occurred, with one referral to the ER.  Home management was recommended in 38 encounters.

Conclusion: We spent 4.5 work days (conservative estimate) on care coordination activities for 29 patients in our OPAT program in a 2 month period.  This non-reimbursable work resulted in prevented admissions (2) and ER visits (15).  This pilot provided evidence to next validate the CCMT tool for OPAT and pursue actual cost analyses.  Use of this modified CCMT may help provide justification for institutional support for a pediatric OPAT program and payers looking to formulate payment bundles.

Louise Vaz, MD, MPH1, Cindi Farnstrom, MN, CPNP1, Erin Merrifield, RN, BSN, CCRP1, Kimberly Felder, PA-C2, Penelope Barnes, MBBS, MRCP, FRCPATH, PhD2,3, Hannah Rosenberg, MSc4 and Richard Antonelli, MD, MS4, (1)Pediatric Infectious Diseases, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, (2)Infectious Disease, Oregon Health and Science University, Portland, OR, (3)Orthopaedics and Rehabilitation, Oregon Health and Sciences University, Portland, OR, (4)General Pediatrics, Boston Children's Hospital / Harvard Medical School, Boston, MA

Disclosures:

L. Vaz, None

C. Farnstrom, None

E. Merrifield, None

K. Felder, None

P. Barnes, None

H. Rosenberg, None

R. Antonelli, None

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