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首页> 外文期刊>The Journal of pharmacy technology: jPT : official publication of the Association of Pharmacy Technicians >The Impact of an Infectious Diseases Transition Service on the Care of Outpatients on Parenteral Antimicrobial Therapy
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The Impact of an Infectious Diseases Transition Service on the Care of Outpatients on Parenteral Antimicrobial Therapy

机译：传染病过渡服务对门诊患者胃肠外抗菌治疗的影响

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Abstract Background: Many hospitalized patients with complicated infections are discharged on outpatient parenteral antimicrobial therapy (OPAT). However, little is known about how to improve the postdischarge care of OPAT patients. Objective: The impact of an infectious diseases transitions service (IDTS) on OPAT patient readmissions, as well as on processes of care, was evaluated. Methods: We performed a controlled, quasi-experimental evaluation over 15 months in an academic medical center. Intervention-arm patients, before and after the introduction of an IDTS, were seen by the general infectious diseases consult teams, while control-arm patients (discharged on OPAT after hospitalization with bacteremia) were not. The IDTS prpspectively tracked all OPAT patients and coordinated follow-up. The impact of the IDTS was calculated using a differences-in-differences approach where the interaction between time (before vs after the IDTS intervention) and study arm (intervention vs control arm) was the variable of interest. The control arm was used only in primary outcome analyses (readmissions and emergency department visits). Secondary outcomes included process of care measures and non-readmission clinical outcomes. Results: Of 488 consecutive patients requiring OPAT, 362 were in the intervention arm (215 pre-intervention and 147 post-intervention) and 126 in the control arm (70 pre-intervention and 56 post-intervention). Compared to the control arm, the IDTS was not associated with changes in 60-day readmissions and/or emergency department visits (adjusted odds ratio [OR] = 0.48; 95% confidence interval [Cl] = 0.13-1.79). In the intervention arm, implementation of the IDTS was associated with fewer antimicrobial therapy errors (OR = 0.062; 95% Cl = 0.015-0.262), increased laboratory test receipt (OR = 27.85; 95% Cl = 12.93-59.99), and improved outpatient follow-up (OR = 2.44; 95% Cl = 1.50-3.97). Conclusions: In a controlled evaluation, the IDTS did not affect readmissions despite improving process of care measures for targeted patients. Care coordination services may improve OPAT quality of care, but their relationship to readmissions is unclear.
机译：摘要背景：许多住院并发感染的患者因门诊肠胃外抗菌治疗（OPAT）而出院。但是，关于如何改善OPAT患者的出院后护理知之甚少。目的：评估了传染病过渡服务（IDTS）对OPAT患者再入院以及护理过程的影响。方法：我们在一个学术医学中心进行了为期15个月的对照半实验评估。普通传染病咨询小组在引入IDTS之前和之后都对干预组患者进行了观察，而对对照组的患者（因菌血症住院后在OPAT出院）则没有。 IDTS预先追踪了所有OPAT患者并进行了协调随访。使用差异差异方法计算IDTS的影响，其中时间（IDTS干预之前或之后）与研究组（干预组与对照组）之间的相互作用是关注变量。该控制臂仅用于主要结果分析（重新入院和急诊室就诊）。次要结果包括护理措施过程和非再入院临床结果。结果：在488名需要OPAT的连续患者中，362例在干预组（215例在干预前，147例在干预后），126例在对照组中（126例在干预前70例，在干预后56例）。与对照组相比，IDTS与60天再入院和/或急诊就诊的变化无关（调整后的优势比[OR] = 0.48; 95％置信区间[Cl] = 0.13-1.79）。在干预领域，IDTS的实施与更少的抗微生物治疗错误有关（OR = 0.062; 95％Cl = 0.015-0.262），增加的实验室测试接收率（OR = 27.85; 95％Cl = 12.93-59.99）并有所改善门诊随访（OR = 2.44; 95％Cl = 1.50-3.97）。结论：在一项对照评估中，尽管针对目标患者的护理措施有所改进，但IDTS并未影响再次入院。护理协调服务可以提高OPAT的护理质量，但是它们与再入院的关系尚不清楚。

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