PDF(Pubmed)
Abstract：
UNASSIGNED: Outpatient parenteral antimicrobial therapy (OPAT) is a safe and cost-effective transitional care approach administered via different delivery models. No standards exist for appropriate OPAT program staffing. We examined outcomes of patients receiving OPAT via different care models to identify strategies to improve safety while reducing health care overuse.
UNASSIGNED: Retrospective demographic, clinical, and outcome data of patients discharged with OPAT were reviewed in 2 periods (April-June 2021 and January-March 2022; ie, when staffing changed) and stratified by care model: self-administered OPAT, health care OPAT, and skilled nursing facility OPAT.
UNASSIGNED: Of 342 patients, 186 (54%) received OPAT in 2021 and 156 (46%) in 2022. Hospital length of stay rose from 12.4 days to 14.3 in 2022. In a Cox proportional hazards regression model, visits to the emergency department (ED) within 30 days of OPAT initiation (hazard ratio, 1.76; 95% CI, 1.13-2.73; P = .01) and readmissions (hazard ratio, 2.34; 95% CI, 1.22-4.49; P = .01) increased in 2022 vs 2021, corresponding to decreases in OPAT team staffing. Higher readmissions in the 2022 cohort were for reasons unrelated to OPAT (P = .01) while readmissions related to OPAT did not increase (P = .08).
UNASSIGNED: In a well-established OPAT program, greater health care utilization-length of stay, ED visits, and readmissions-were seen during periods of higher staff turnover and attrition. Rather than blunt metrics such as ED visits and readmissions, which are influenced by multiple factors besides OPAT, our findings suggest the need to develop OPAT-specific outcome measures as a quality assessment tool and to establish optimal OPAT program staffing ratios.
UNASSIGNED: Retrospective demographic, clinical, and outcome data of patients discharged with OPAT were reviewed in 2 periods (April-June 2021 and January-March 2022; ie, when staffing changed) and stratified by care model: self-administered OPAT, health care OPAT, and skilled nursing facility OPAT.
UNASSIGNED: Of 342 patients, 186 (54%) received OPAT in 2021 and 156 (46%) in 2022. Hospital length of stay rose from 12.4 days to 14.3 in 2022. In a Cox proportional hazards regression model, visits to the emergency department (ED) within 30 days of OPAT initiation (hazard ratio, 1.76; 95% CI, 1.13-2.73; P = .01) and readmissions (hazard ratio, 2.34; 95% CI, 1.22-4.49; P = .01) increased in 2022 vs 2021, corresponding to decreases in OPAT team staffing. Higher readmissions in the 2022 cohort were for reasons unrelated to OPAT (P = .01) while readmissions related to OPAT did not increase (P = .08).
UNASSIGNED: In a well-established OPAT program, greater health care utilization-length of stay, ED visits, and readmissions-were seen during periods of higher staff turnover and attrition. Rather than blunt metrics such as ED visits and readmissions, which are influenced by multiple factors besides OPAT, our findings suggest the need to develop OPAT-specific outcome measures as a quality assessment tool and to establish optimal OPAT program staffing ratios.
摘要：
■门诊肠胃外抗菌治疗（OPAT）是一种安全且具有成本效益的过渡护理方法，可通过不同的分娩模式进行。没有适当的OPAT计划人员配备标准。我们检查了通过不同护理模式接受OPAT的患者的结果，以确定提高安全性同时减少医疗保健过度使用的策略。
■回顾性人口统计，临床,和OPAT出院患者的结果数据在2个时期（2021年4月至6月和2022年1月至3月；即，当人员配置发生变化时)，并按护理模式分层：自我管理的OPAT，医疗保健OPAT,和熟练的护理机构OPAT。
■在342名患者中，2021年有186人（54%）获得OPAT，2022年有156人（46%）。2022年，住院时间从12.4天上升到14.3天。在Cox比例风险回归模型中，OPAT启动后30天内访问急诊科(ED)(危险比，1.76；95%CI，1.13-2.73；P=0.01）和再入院（危险比，2.34；95%CI，1.22-4.49；P=0.01）2022年比2021年增加，对应于OPAT团队人员减少。2022年队列中更高的再入院原因与OPAT无关（P=0.01），而与OPAT相关的再入院没有增加（P=.08）。
■在一个完善的OPAT计划中，提高医疗保健利用率-住院时间，ED访问，和重新接纳——在工作人员更替和自然减员较高的时期出现。而不是直截了当的指标，如ED访问和再入院，除了OPAT之外，还受到多种因素的影响，我们的研究结果表明,需要开发OPAT特异性结局指标作为质量评估工具,并建立最佳的OPAT计划人员配备比例.
■回顾性人口统计，临床,和OPAT出院患者的结果数据在2个时期（2021年4月至6月和2022年1月至3月；即，当人员配置发生变化时)，并按护理模式分层：自我管理的OPAT，医疗保健OPAT,和熟练的护理机构OPAT。
■在342名患者中，2021年有186人（54%）获得OPAT，2022年有156人（46%）。2022年，住院时间从12.4天上升到14.3天。在Cox比例风险回归模型中，OPAT启动后30天内访问急诊科(ED)(危险比，1.76；95%CI，1.13-2.73；P=0.01）和再入院（危险比，2.34；95%CI，1.22-4.49；P=0.01）2022年比2021年增加，对应于OPAT团队人员减少。2022年队列中更高的再入院原因与OPAT无关（P=0.01），而与OPAT相关的再入院没有增加（P=.08）。
■在一个完善的OPAT计划中，提高医疗保健利用率-住院时间，ED访问，和重新接纳——在工作人员更替和自然减员较高的时期出现。而不是直截了当的指标，如ED访问和再入院，除了OPAT之外，还受到多种因素的影响，我们的研究结果表明,需要开发OPAT特异性结局指标作为质量评估工具,并建立最佳的OPAT计划人员配备比例.
