1942. Expansion of Outpatient Parenteral Therapy Program with Addition of Advanced Practice Providers Can Lead to Reduced Readmission Rates

Abstract

BackgroundThe addition of Advanced Practice Providers (APPs) such as Nurse Practitioners or Physician Assistants as hospital-based service providers has been shown to increase efficiency of care, provide for better continuity of care across the inpatient and outpatient settings, and facilitate interdisciplinary collaboration. As healthcare systems attempt to not only increase access to care but also improve quality, the addition of APPs is becoming an option to meet division-specific goals. To decrease readmissions and increase access to care for patients discharged on intravenous (IV) antibiotics and in the Outpatient Parenteral Antibiotic Therapy (OPAT) Program, the Division of Infectious Diseases at UPMC Presbyterian hired two APPs in early 2017. Our aim was to compare readmission and follow-up rates from the time before expansion of the program with APPs to after expansion.MethodsWe completed a retrospective study of all OPAT patients seen by any Infectious Diseases (ID) provider (MD or APP) n the period from January to May 2017 (prior to APP outpatient clinics with OPAT patients) and in the period from January to February 2018. The total number of patients seen by an ID provider and the 30-day readmission rates were collected and evaluated. A comparison of proportions was done with a two-tailed z-test for the percentage of readmissions prior to program expansion compared with the percentage of readmissions after program expansion.ResultsFollowing the expansion of the OPAT program with the addition of two APPs in 2017, there was a decrease, from 14.7% to 9.6%, in 30-day readmissions for all patients who were seen for follow-up (P = 0.0461, 95% CI 0.0672–9.3164). The percentage of patients who were seen for follow-up increased after expansion of the program from 29.5% to 39.3% (P = 0.0051, 95% CI 2.8714–16.9153).ConclusionExpansion of the OPAT program within the Division of Infectious Diseases at UPMC with the addition of two APPs has significantly increased access to care and significantly decreased 30-day readmissions when the patient was seen for follow-up by an ID provider (MD or APP).Disclosures All authors: No reported disclosures.

Advanced practice providers in the infectious disease workforce: A nationwide utilization survey

“…The University of Pittsburgh described such expansion with APP additions to their OPAT Program, and demonstrated successful reduction in 30-day readmissions from 14.7% down to 9.6%. 11 The addition of APPs also allowed for expansion of follow-up care from 29.5% to 39.3% for their OPAT population. Similarly, the University of Texas MD Anderson Cancer Center also described their expansion of APP services on their immunocompromised ID service, noting a 48% increase in inpatient consults, and 74% increase for outpatient consults from 2006 – 2009.…”

Advanced practice providers in infectious disease: Enhancing the infectious disease team of the future

“…Meanwhile, APPs also contributed greatly Antimicrobial Therapy (OPAT). 8 They retrospectively studied all OPAT patients seen in a 6-month period prior to APP utilization and compared this to a 6-month period after the integration of APPs into their OPAT clinic. Following the integration and expansion of their OPAT program with APPs, there was a decrease in 30-day readmission from 14.7% to 9.6% with an increase in patients seen for follow-up in the outpatient clinic from 29.5% to 39.3%.…”

“…A second group from the University of Pittsburgh Medical Center also published their experience with APPs in Outpatient Parenteral Antimicrobial Therapy (OPAT) 8 . They retrospectively studied all OPAT patients seen in a 6‐month period prior to APP utilization and compared this to a 6‐month period after the integration of APPs into their OPAT clinic.…”

Integrating Infectious Disease Advanced Practice Providers in the Workforce: An Educational Step Forward

“…Across the United States, there is uneven distribution of ID physicians, and using APPs as physician-extenders in underserved areas could offer enhanced care to these populations [ 2 ]. Although groups including MD Anderson, University of Pittsburgh Medical Center, and Lurie Children's Hospital have described integration of APPs into ID, little has been published concerning education and onboarding [ 3 , 4 , 5 ]. The paper by Smith et al gives a blueprint and a methodology for this, with milestones of achievement and ID knowledge [ 1 ].…”