Identification of Essential Outpatient Parenteral Antimicrobial Therapy (OPAT) Bundle Elements to Optimize Patient Outcomes in an Academic Health-System

Introduction Outpatient parenteral antimicrobial therapy (OPAT) services are becoming increasingly popular for institutions to implement due to the cost effectiveness and reduction in readmission rates for patients successfully started on appropriate therapy. OPAT services have varying infrastructure at different health-systems due to the resources available to support them, monetary limitations, and patient populations served. Based on current literature, different components have been identified to help reduce complications, decrease readmission rates, and improve mortality. The purpose of this study is to evaluate if high compliance with our predefined OPAT Bundle in a retrospective cohort is associated with decreased 30-day readmission rates and to identify any additional patient- or disease-specific risk factors for consideration of inclusion. Research Question What elements impact 30-day readmission rates in patients receiving outpatient parenteral antimicrobial therapy? Hypothesis Compliance with a tailored OPAT Bundle will have lower rates of 30-day readmission in patients discharged on IV antibiotics. Methods This is a single health-system, multi-center, retrospective study of patients who received post- discharge intravenous antibiotics between January 2023-December 2023. The following criteria will be assessed from the electronic health record: timing of infectious disease (ID) consultation, timing of case management consultation, type of patient insurance, definitive positive cultures, IV access type and timing, outpatient follow-up, and cohort demographics. Univariate and multivariable analysis were performed to assess association with the primary endpoint, readmission within 30 days of discharge. Results A total of 2231 patients were assessed – 69 patients had high compliance with our Bundle and 2162 patients did not have high compliance. Seven hundred and thirty-three patients were readmitted within 30 days of discharge from their initial visit and 1498 patients were not readmitted within 30 days. Baseline characteristics of both cohorts included male (50.1% versus 54.6%, P = 0.044) and age (mean ± SD; 63.6 ± 16.5 versus 63.3 ± 15.8, p = 0.729). Overall, 3.1% of patients who were readmitted had high compliance with our OPAT Bundle, while 3.1% of patients not readmitted had high compliance (P = 0.932). Independent risk factor analysis identified possible health disparities to be targeted in future OPAT program implementation. Conclusion Strategic and systematic OPAT program development utilizing internal cohorts for risk factors exploration, identified and quantified intervention targets of interest. Although we did not see a significant difference between high compliance or low compliance, the study results remain encouraging and highlight the importance of standardized screening, education, and follow-up in patients receiving antibiotics in the outpatient setting of which pharmacists would have a great impact on.

Name thesis:degree_name

Master of Science

Discipline thesis:degree_discipline

Pharmacy Administration and Leadership

Grantor

University of Houston

Year dc:date.issued

2025

Author dc:creator

• Korzec, Kalina Qiu Ju 1999-

Advisor dc:contributor.advisor

• Eubank, Taryn A.

Committee members dc:contributor.committeemember

• Patel, Shivani
• Finch, Natalie
• Liebl, Michael
• Truong, Mabel

• Pharmacy management
• Pharmacology
• Pharmaceutical services

Language dc:language.iso

English

Handle dc:identifier.uri

https://hdl.handle.net/10657/19550

OAI identifier oai:identifier

oai:uh-ir.tdl.org:10657/19550