Background: Outpatient parenteral antimicrobial therapy (OPAT) reduces prolonged hospitalization and associated risks, but poor standardization and implementation increase readmission rates, which hover around 25%. The Infectious Diseases Society of America (IDSA) recommends structured, multidisciplinary OPAT programs to optimize safety and outcomes. Twelve quality indicators spanning organization, initiation, continuation, and outcome domains were proposed to promote improvement and high-quality OPAT care. These quality indicators were derived through review of the literature for the period January 1, 2013, to October 20, 2016, and expert panel consensus using the Delphi process. Our scoping review examined the association between reported OPAT quality indicators and patient readmission including data. Its aim is to identify the most impactful quality indicators for reducing readmission.
Methods: We followed Arksey and O’Malley’s scoping review framework and PRISMA-ScR reporting guidelines. PubMed, Embase, Cochrane CENTRAL, Web of Science, and Google Scholar were searched from database inception through May 1, 2025, for studies of adult patients discharged on OPAT. Inclusion criteria included patients managed by multidisciplinary teams and with reported readmission rates. We extracted data on study design, readmission rates, multidisciplinary teams, and presence (yes/no) of each quality indicator. We categorized readmission rates as low (< 10%) or high (≥10%).
Results: Of 2613 unique studies screened, 18 (5,027 patients) were included, and half were US-based. Readmission rates ranged from 0–27.9%. All studies reported a Structured OPAT Program and a Formal OPAT Team. Initial patient assessment by a competent team member was more common in studies with lower readmissions. Reporting more quality indicators (range 4-11) did not clearly correlate with fewer readmissions. All multidisciplinary programs included an infectious diseases physician; 94% included nurses and 55% included pharmacists. Only 28% included social workers, and 11% included hospitalists.
Conclusions: Consistent with guidelines, use of initial assessments for patient eligibility within a structured OPAT program was associated with lower readmission rates. Underrepresentation of hospitalists and social workers suggests opportunities to strengthen care transitions and patient support. Hospitalists often play a key role in transitions of care, bridging inpatient and outpatient management, and theoretically increasing their involvement for example by integration of OPAT into standard discharge workflows as applicable, could potentially lower the burden on ID specialists. Our scoping review aimed to map existing evidence rather than establish causality. Differences in study designs and reporting of outcomes and quality indicators limited comparability and precluded meta-analysis. In conclusion, structured multidisciplinary programs determining patient eligibility for OPAT were associated with lower readmissions than those lacking these assessments. Future research should prioritize how to best engage members of the multidisciplinary team and how quality indicators focused on continuation and outcome domains influence patient safety and program efficiency.
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