Parkland Hospital, an 800-bed safety-net facility serving Dallas County, Texas, is teaching uninsured patients how to self-administer intravenous (IV) antibiotics for outpatient parenteral antimicrobial therapy (OPAT), and the innovative approach appears to be paying off. The program lowered 30-day readmission rates by 47% over a four-year period, according to a study published in PLOS Medicine.
Because uninsured patients in the United States usually can’t afford OPAT, safety-net hospitals are often burdened with long hospitalizations to infuse antibiotics, occupying beds that could be used for patients requiring more intensive services, according to the article. Parkland established a self-administered OPAT (S-OPAT) clinic in 2009 to shift care of selected uninsured patients to self-administration of their IV antibiotics at home.
From January 1, 2009 to October 14, 2013, all uninsured patients meeting the hospital’s criteria were enrolled in S-OPAT, while insured patients were discharged to health care-administered OPAT (H-OPAT) settings. The S-OPAT patients were trained to self-administer IV antimicrobials by gravity, were tested for competency before discharge, and were followed at designated intervals in the S-OPAT outpatient clinic for IV access care, laboratory monitoring, and physician follow-up. The study’s primary outcome was 30-day all-cause readmission, and the secondary outcome was one-year all-cause mortality.
Of the 1,168 patients discharged to receive OPAT, 944 (81%) were managed in the S-OPAT program and 224 (19%) by H-OPAT services. The 30-day readmission rate was 47% lower in the S-OPAT group (adjusted hazard ratio [aHR], 0.53; P = 0.003), and the one-year mortality rate did not differ significantly between the two groups (aHR, 0.86; P = 0.73). The S-OPAT program shifted a median 26 days of inpatient infusion per patient to the outpatient setting, avoiding 27,666 inpatient days.
The authors concluded that S-OPAT can be an acceptable model of treatment for uninsured, medically stable patients.
“By offering the choice of the home environment over a skilled nursing facility, and the freedom of scheduling infusions not available with scheduled home health services, our model may also be an attractive option for patients with funding and access to third-party health care services,” they wrote.
In an interview with HealthLeaders Media, lead author Kavita Bhavan, MD, explained that OPAT has been around since the late 1970s. It was first shown to work in pediatric populations, and then in adults.
“I think [the program’s success] is ownership of one’s health, tapping into this phenomenon of patient engagement and patient empowerment,” she said.