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As health care shifts from reimbursement based on numbers of patients seen or procedures performed, to reimbursement based on quality of care, the infectious diseases specialty is challenged to accurately reflect the complex, expert care that ID physicians provide. One way could be outpatient parenteral antimicrobial therapy, or听OPAT, which monitors patients who are discharged from the hospital on intravenous antibiotics to treat serious infections. These may be for bone and joint infections, infections in the lungs, heart or bloodstream, or complicated infections of the skin and soft tissue. The OPAT concept has been around for 30+ years, but only recently have hospital systems begun to measure its success. OPAT infectious diseases physician Brian Bramson, MD, sees the efficiencies and the patient satisfaction.

鈥淎 patient came to us after undergoing a urology procedure from a different care facility, and she was experiencing complications after the surgery. Our OPAT team established a treatment plan that has enabled her to receive IV antibiotics at home. She has repeatedly expressed how helpful and engaged the team has been in her care,鈥� Dr. Bramson said.

That patient was referring to a proactive and supportive team that stayed in touch with her throughout the care continuum. Terre Oosterwyk, MSN, RN, OPAT鈥檚 program manager explained the service.

鈥淲e manage the care for patients who are medically ready to go home but need to continue with IV medicine to treat an infection. Our program allows that transition of care from an inpatient setting to a post-acute setting, with patient care safely delivered in the home,” Oosterwyk said.

Matching the Drug with the Bug

Angela Perhac, PharmD, BCIDP, CPP, has a vital role, helping determine which bug is involved with an infection, which drug is best, and the frequency needed, along with the appropriate device for the home setting.

听鈥淎 culture is the best way to tell what is needed, and we start by testing the organism against different drugs to see if it is susceptible or resistant,鈥� said Perhac. 鈥淏ut we don鈥檛 always have bacterial growth on cultures to guide our therapy.鈥�

Perhac compares the task to putting pieces of a puzzle into place.

鈥淚n these cases, we must determine the optimal therapy for these patients. Some drugs cover a lot of organisms, and some target only a few. We prefer to use drugs that target only a few organisms, to prevent resistance and preserve broad-spectrum antibiotics.鈥�

鈥淲e see a variety of infections, including bone and joint infections, endocarditis, intra-abdominal abscesses, and diabetic foot ulcers. In some cases, we use imaging (CT, MRI) as part of the treatment, to evaluate improvement throughout the treatment course,鈥� Perhac said.

Building the Safety Net

Care delivery starts with the onboard call, within 24-72 hours of discharge, at which time the OPAT team explains the role of home health nursing and home infusion, how medication will be administered, and when it will be delivered to the home. During the call, the OPAT team tells patients who to contact with questions related to IV lines or drug side effects. For medication administration or supply questions, patients know to contact the home infusion company or home health nurse. Building this base of information sets the patient up for success.

鈥淭his early touch point makes a difference in how we are able to manage care, such as nausea and vomiting, common side effects of antibiotics,鈥� said Oosterwyk. 鈥淲e are building a safety net by making sure the patient has phone numbers for the clinic during the day, and on-call ID provider for nights, and weekends, and holidays.鈥�

鈥淥ur Clinical Pharmacist Practitioner, Angela, can make medication adjustments and order repeat labs or medications to help with side effects, such as nausea, which can prevent additional ED visits or readmissions.鈥�

With听careful patient selection and antimicrobial management dependent on a team approach, OPAT is keeping 黑料网 patients from being readmitted, with clinical follow-up and weekly monitoring of clinical laboratory results. This leaves hospital beds open for those with critical needs.

Recognized For Quality and Safety

Oosterwyk joined the Division of Infectious Diseases over three years ago after serving as an infusion nurse liaison at 黑料网 Medical Center. Bringing 30 years of nursing experience in home health, critical care, and strategic health management, she coordinates a service that not only delivers safe and appropriate antimicrobial therapy at home it streamlines the treatment process and timeline.

In 2023, 黑料网 Medical Center honored the OPAT Program with a Quality and Safety Award recognizing the team鈥檚 role in reducing hospital readmissions.

鈥淲e work closely with the patient and the physician as one team, and we鈥檙e able to clinically intervene and make quick decisions, for example, on a change at the lab or a visit to the ER. Our service offers a faster response time and clinical intervention when needed,” Oosterwyk said. 鈥淎s our providers have become more comfortable with the program, our numbers have increased tremendously.鈥�

Measuring the Success of the Program

While patient satisfaction is frequently expressed, the decrease in preventable readmissions is measured. At 黑料网 Medical Center, readmission rates have steadily declined in recent years as more patients receive the therapy. Michael Swartwood, MSN, RN, CAPM, OPAT’s data manager, works closely with the OPAT clinical team to monitor the program.

鈥淪ince 2017, patients completing therapy have increased 68% while readmissions during OPAT have decreased from 25% to 11% in 2023,” Swartwood said.

What Referring Providers Need to Know

Patients must be seen by an ID physician prior to a referral to the OPAT program and after discharge, to assess the need for IV, oral, or combination antimicrobial therapy. While most patients are referred from the hospital, the OPAT service is also available in the outpatient setting. In fact, Oosterwyk says the number of patients who have started OPAT in the outpatient setting has doubled since the program began, and this is preventing hospital admissions altogether.

鈥淲e hope providers on different services will see this as an opportunity to utilize the experience and talent within our Division of Infectious Diseases,鈥� Oosterwyk said.

The service may also help to quantify the value ID physicians provide in more complex, difficult cases, where an ID consultation can significantly improve patient outcomes.

The team is led by OPAT director, Mary Catherine Bowman, MD. Other members of the OPAT team include Suzy Rogers, administrative assistant, with provider support from Corazon Halsey, FNP-BC, Brian Bramson, MD, Claire Farel, MD, Nick Mavrogiorgos, MD, and Asher Schranz, MD.