Key Points
- Numerous studies have detailed the benefits of utilizing OPAT in various populations and settings, including private practices, traditional academic programs, and Veterans Affairs medical centers.
- Potential benefits to the healthcare system include shorter or avoided hospital stays, prevention of hospital associated conditions and significant cost savings.
- Advantages of OPAT to patients include the ability to return to work or school faster, care for children or dependents and, generally, to resume activities of daily living with minimal interruption in their life.
Models of Care
Table 1. Models of Care
| Model | Infusion location | Who performs administration | Patient training location |
|---|---|---|---|
| Home | Home | Self/Caregiver | Home |
| Nursing location | Comments | Advantages | Disadvantages |
| Home1 | “Home Infusion” Weekly home nursing visits for supplies, line care, labs2 | Patient convenience. Regular skilled clinical assessments. Opportunity for home inspection. Availability of a registered nurse on 24 hr basis. | Requires patient/caregiver competence and compliance. Requires reliable home infusion nursing. Increased cost to patient in the absence of home infusion insurance benefit. May entail substantial copays. |
| Model | Infusion location | Who performs administration | Patient training location |
| Home | Home | Self/Caregiver | Office |
| Nursing location | Comments | Advantages | Disadvantages |
| Office | “Teach and Train” Weekly office visits for supplies, line care, labs, nursing | Patient convenience. Regular skilled clinical assessments. | Requires patient/caregiver competence and compliance. |
| Model | Infusion location | Who performs administration | Patient training location |
| Home | Home | HCW | No training |
| Nursing location | Comments | Advantages | Disadvantages |
| Home | “Hospital at home” Twice daily home nursing visits and once daily home MD visits | Cost savings for patient who would otherwise be hospitalized. Potential for reduced HACs and increased patient satisfaction. | Not reimbursed by traditional fee for service payors. Limited uptake in US but may be expanding. |
| Model | Infusion location | Who performs administration | Patient training location |
| Infusion center | Office-based | HCW | None |
| Nursing location | Comments | Advantages | Disadvantages |
| ID office | “Office Infusion” Daily visits with nursing | High degree of clinical oversight. Usually covered by Medicare. Minimizes out-of-pocket costs to patient. Potential for weekly office visits with ID physician. | Patient must be able to travel daily. Requires extensive infr/structure and weekend office staffing. Limited to once daily dosing of antimicrobials. |
| Model | Infusion location | Who performs administration | Patient training location |
| Infusion center | Non-office-based3 | HCW | None |
| Nursing location | Comments | Advantages | Disadvantages |
| Hospital-based | “Non-office Infusion” Daily visits with nursing | High degree of clinical oversight. Usually covered by Medicare. Minimizes out-of-pocket costs to patient. | Patient must be able to travel daily. Requires extensive infrastructure and weekend office staffing. Limited to once daily dosing of antimicrobials. |
| Model | Infusion location | Who performs administration | Patient training location |
| Skilled Nursing Facility | Skilled Nursing Facility | HCW | None |
| Nursing location | Comments | Advantages | Disadvantages |
| Skilled Nursing Facility | Nursing on site | Usually covered by payers/Medicare. Other skilled nursing needs (physical therapy, wound care, etc.) can be met. May be less labor-intensive for supervising physicians when treating patients with multiple comorbid conditions. Minimizes out-of-pocket costs to patient. | Variable levels of clinical oversight. Patients may dislike staying in SNF. May exhaust patient’s SNF benefits. Most expensive for overall healthcare system. |
2 More frequent nursing visits may be possible
3 May be hospital-based, free standing or emergency room