Can implementation of a complex outpatient antimicrobial therapy program reduce readmissions for patients with bone and joint infections?

TL;DR

A new outpatient antimicrobial therapy program led by advanced providers improves follow-up care for patients with bone and joint infections.

Contribution

The study introduces a complex outpatient antimicrobial therapy program led by advanced practice providers to enhance post-discharge care.

Findings

Post-discharge follow-up time decreased significantly after implementing the COpAT program.

The percentage of patients seen within 14 days of discharge increased from 42% to 83%.

TOC pharmacy engagement rose from 8% to 42%, aiding in medication error correction and treatment adjustments.

Abstract

Evaluate whether a complex outpatient antimicrobial therapy (COpAT) program led by advanced practice providers (APPs) conducting transition-of-care (TOC) services improves post discharge patient follow-up and reduces hospital readmission.

Pre- and postimplementation cohort study comparing outcomes 6 months before and 5 months after COpAT launch.

706-bed tertiary university teaching hospital.

Adult patients admitted to the hospital with bone and joint infections, seen by our inpatient infectious disease consultation service and discharged with at least fourteen days of antimicrobial therapy, with follow-up at our specialized musculoskeletal infectious diseases clinic.

The APP led pilot COpAT program was launched on March 1st, 2024, with a multidisciplinary team including an infectious diseases physician, APP, nurse, medical assistant, and TOC pharmacists. Patients enrolled at hospital discharge and were scheduled for APP-led TOC visits within fourteen days, followed by a physician visit.

The pre- and post-intervention groups included 100 and 135 patients, respectively. Mean postdischarge follow-up time decreased from 20.1 to 9.1 days (P < .001), and patients seen within fourteen days increased from 42% to 83% (P < .001). Readmission rates and emergency room visits did not change significantly. TOC pharmacy engagement rose from 8% to 42% (P < .001), and both TOC pharmacy and APP interventions frequently addressed medication errors, side effects, and treatment modifications.

A structured, COpAT program with APP and TOC pharmacy involvement optimizes postdischarge follow-up, strengthens antimicrobial outpatient monitoring, and supports timely intervention for patients with complex infections.

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