Propensity Score–Weighted Analysis of the Impact of Outpatient Parenteral Antimicrobial Therapy Plan Reconciliation on Unscheduled Care

Abstract

Background. Outpatient parenteral antimicrobial therapy (OPAT) is a mechanism for delivery of antimicrobial therapy outside of inpatient care; however, risks associated with OPAT combined with transition-of-care vulnerabilities may result in unscheduled healthcare use. On 15 June 2020, our institution launched a program entailing OPAT plan review and reconciliation by infectious diseases (ID) pharmacists prior to hospital discharge. We analyzed the frequency of all-cause 90-day emergency department (ED) visits, readmissions, and mortality of patients pre- and postimplementation of OPAT plan reconciliation. Methods. Unique, adult OPAT recipients discharged to home or a postacute care facility from an academic hospital before (1 June 2017–14 June 2020) and after (15 June 2020–30 June 2022) implementation of ID pharmacist review and reconciliation of OPAT plans were included. We performed a propensity score–weighted analysis to compare 90-day outcomes pre- and postintervention while adjusting for relevant clinical characteristics. We accounted for missing data by using multiple imputation. Results. A total of 2408 OPAT patients met inclusion criteria: 1650 preimplementation and 758 postimplementation. Patients in the postimplementation group had statistically fewer ED visits (pre: 22.2%; post: 17.8%; P = .02) and hospital readmissions (pre: 38.9%; post: 33.4%; P = .01) within 90 days after discharge from index admission when compared to the preimplementation cohort. There was no significant difference in the 90-day all-cause mortality between cohorts. Conclusions. Following implementation of OPAT plan reconciliation by ID pharmacists prior to discharge from acute care, OPAT recipients were significantly less likely to experience 90-day ED visits or 90-day readmissions.