Abstract
ABSTRACTObjective: This study aimed to evaluate the efficiency of treatment of infectious endocarditis (IE) via Self-administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT) supported by a shortening hospital admission program in a hospitalization-at-home unit (HAH), including a short review of the literature.Methods: Ambispective cohort study of 57 episodes of IE in 54 patients treated in an HAH unit between 1988 and 2014 who receive S-OPAT after prior intra-hospital clinical stabilization. Characteristics of each episode of IE, safety and efficiency of the care model, were analyzed.Results: Forty-three (76%) patients were males with a median age of 61 years (SD = 16.5). A total of 37 (65%) episodes affected the native valve (42% the aortic valve). In 75%, a micro-organism was isolated, of which 88% were Gram-positive bacteria. No deaths occurred during HAH program, clinical complications appeared in 30% of episodes, only 6 patients were re-admitted to hospital although no patient died. In the 12 months’ follow-up 3 cases had a recurrence. The average cost of a day stay in HAH was €174 while in traditional cardiology hospitalization was €1100. The total average cost of treatment of each episode of IE managed entirely in hospital was calculated as €54,723. Application of the S-OPAT model based on HAH meant a cost reduction of 32.72%.Conclusions: In suitably selected patients, treatment of IE based on S-OPAT supported by a shortening hospital admission care program by means of referral to a HAH unit is a safe and efficient care model which entails a significant cost saving for the public healthcare system.
Highlights
Infectious endocarditis (IE) is one of the most serious infectious diseases because of its acute and unpredictable clinical course [1]
In suitably selected patients, treatment of IE based on Selfadministered Outpatient Parenteral Antimicrobial Therapy (S-Outpatient Parenteral Antimicrobial Therapy (OPAT)) supported by a shortening hospital a admission care program by means of referral to a hospitalization-at-home unit (HAH) unit is a safe and efficient care model which entails a significant cost saving for the public healthcare system
General criteria for S-OPAT treatment of IE s within the HAH program are summarized in Table 1. u The efficiency of S-OPAT was first estimated by calculating the cost per day of stay in the HAH by means of the sum of direct costs and costs charged for other hospital services and structures
Summary
Infectious endocarditis (IE) is one of the most serious infectious diseases because of its acute and unpredictable clinical course [1]. Its treatment consumes a large amount of financial resources because of prolonged hospital stay (arising from long term recommendations for parenteral antimicrobial treatment). There are hardly any works that evaluate the overall costs of its hospital t treatment. Ip Efficiency in the healthcare setting is estimated by means of financial evaluation of costs entailed by comprehensive management of the disease. Alternative care models to traditional hospitalization that c reduce or avoid hospital admission without detriment to a benefit on health should markedly increase efficiency s during treatment of hospital processes. U Outpatient Parenteral Antimicrobial Therapy (OPAT), is an alternative care model to traditional hospitalization that has been demonstrated to be effective and safe in many infectious processes [6,7]. Most OPAT programs [8]
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