New research published in Clinical Infectious Diseases describes the systematic development of 33 quality indicators for optimal outpatient parenteral antimicrobial therapy (OPAT). According to the study authors, these quality indicators are useful to assess and improve the quality of care provided by OPAT teams.

Investigators used a RAND-modified Delphi procedure to develop their set of quality indicators by first obtaining recommendations on appropriate OPAT care through systemic literature review and translating these into potential quality indicators. These were then appraised and prioritized by a multidisciplinary panel of experts in 2 questionnaire rounds combined with a meeting between rounds.

The procedure yielded 33 OPAT specific recommendations and 12 quality indicators describing recommended OPAT care were further prioritized by the panel. The 12 prioritized quality indicators are as follows:

1. quality indicators a structured OPAT program

2. a formal OPAT care team

3. a policy on patient selection criteria

4. a treatment and monitoring plan

5. assessment for OPAT should be performed by the OPAT team

6. patients and family should be informed about OPAT

7. the presence of a mechanism for urgent discussion and review of emergent clinical problems

8. a system in place for rapid communication

9. laboratory results should be delivered to physicians within 24 hours

 10. the OPAT team should document clinical response to antimicrobial management

 11. document adverse events

 12. monitor quality indicators for OPAT care and make these data available

Investigators believe that by using the Delphi procedure they combined scientific evidence with expert opinion and that this is a well-established method for quality indicators development. The diversity of expertise on the panel was also considered a study strength, as was the inclusion of 3 panel members who were involved in the development of the Infectious Disease Society of America guideline for OPAT care.

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They also noted several limitations to this work. The first being that the studies selected by the systematic review were mainly retrospective cohort studies with low quality evidence. Second, only 42% of the first-round respondents attended the consensus meeting, and only 2 of the attendees were international experts. However, the results of the consensus meeting were presented to all first-round respondents for additional comments, and the response rate to the second-round questionnaire was 95%. Finally, whereas these quality indicators represent a crucial first step to assess and improve the quality of OPAT care, the applicability of these quality indicators in daily practice remains to be determined. According to investigators, the next step is to facilitate acceptance and subsequently implementation of these quality indicators in everyday practice.

The number of patients receiving OPAT is rising in large part because of increasing antimicrobial resistance and therefore fewer oral treatment options. The results of this work, according to investigators, “describe a clear framework for safe treatment at home,” which they say, “can be used in clinical practice to assess and improve the quality of care provided by OPAT teams throughout the entire OPAT care pathway.”

Reference

Berrevoets MAH, ten Oever J, Oerlemans AJM, Kullberg BJ, Hulscher ME, Schouten JA. Quality indicators for appropriate outpatient parenteral antimicrobial therapy (OPAT) in adults: a systematic review and RAND-modified Delphi procedure [published online May 6, 2019]. Clin Infect Dis. doi:10.1093/cid/ciz362