Nav: Home

Patient-administered antimicrobial infusions at home may allow shorter hospital stays

December 15, 2015

Patients trained to administer their own intravenous antibiotics at home (self-administered outpatient parenteral antimicrobial therapy or S-OPAT), achieved similar or better outcomes compared to patients who received healthcare-delivered OPAT (H-OPAT) with assistance from a home-care nurse or skilled nursing facility, according to a paper published this week in PLOS Medicine. The study, by Kavita P. Bhavan MD, MHS of the University of Texas Southwestern Medical Center, Dallas, Texas, and colleagues, found that uninsured patients taught to perform S-OPAT had lower rates of hospital readmission and similar rates of mortality when compared with insured patients who received H-OPAT.

The research was performed at Parkland Hospital, a safety-net hospital serving Dallas County, Texas. The study included 944 uninsured patients who received care in the S-OPAT program, which included training and weekly monitoring in an outpatient clinic, but who administered their antimicrobials on their own at home. The program also analyzed 224 insured patients who were discharged to receive H-OPAT services. Bhavan and colleagues found the rate of hospital readmission within 30 days was 16.7% in the S-OPAT group, compared to 23.7% in the H-OPAT group. When the researchers used a propensity score to take into account preexisting differences between patients in the two programs and adjusted for several confounding factors, they calculated the risk of readmission for S-OPAT patients to be about half that of H-OPAT patients. They also found the risk of dying within one year of hospital discharge did not differ significantly between the two groups, though the study did not include enough patients to be able to detect a small difference in mortality between groups. The authors note that despite the propensity score levelling and adjustment for known confounders, these results may still be affected by unmeasured differences between the two patient groups, and a randomized controlled trial would be required to determine whether S-OPAT actually improves outcomes compared to H-OPAT.

Nevertheless, these findings suggest that S-OPAT may allow medically stable patients to administer their own intravenous antibiotics safely at home, shortening their hospital stays and making hospital beds available for other patients with more intensive needs. In this study S-OPAT was estimated to have averted a median of 26 inpatient days per patient, and a total of 27,666 days over the 4 years of the study.

The authors say that their findings "have important implications for healthcare financing agencies and for improving resource utilization in safety-net hospitals and other resource-limited settings that care for uninsured patients."
Research Article


The authors received no specific funding for this work.

Competing Interests:

The authors have declared that no competing interests exist.


Bhavan KP, Brown LS, Haley RW (2015) Self-Administered Outpatient Antimicrobial Infusion by Uninsured Patients Discharged from a Safety-Net Hospital: A Propensity-Score-Balanced Retrospective Cohort Study. PLoS Med 12(12): e1001922. doi:10.1371/journal.pmed.1001922

Author Affiliations:

Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Center, Dallas, Texas, United States of America

Parkland Health and Hospital System, Dallas, Texas, United States of America

Division of Epidemiology, Department of Internal Medicine, University of Texas Medical Center, Dallas, Texas, United States of America



Kavita P. Bhavan MD, MHS
UT Southwestern Medical Center
Department of Internal Medicine
5323 Harry Hines Blvd
Dallas, TX 75390-9113


Related Mortality Articles:

Highest mortality risks for poor and unemployed
Large dataset shows that income, work status and education have a clear influence on mortality in Germany.
Addressing causes of mortality in Zambia
Despite the fact that people in sub-Saharan Africa are now living longer than they did two decades ago, their average life expectancy remains below that of the rest of the world population.
Examining the link between caste and under-five mortality in India
In India, children that belong to disadvantaged castes face a much higher likelihood of not living past their fifth birthday than their counterparts in non-deprived castes.
Mortality rates rising for Gens X and Y too
Declining life expectancies in the US include Gen X and Y Americans, in addition to the older Baby Boomers.
Trust in others predicts mortality in the United States
Do you trust other people? It may prolong your life.
Breast cancer screening does not reduce mortality
Fewer and fewer women die from breast cancer in recent years but, surprisingly, the decline is just as large in the age groups that are not screened.
Cold fronts may increase stroke mortality
Study conducted in Southern Hemisphere's subtropical zone detects correlation between drop in temperature and rise in deaths from stroke, especially among women and older people.
Far 'over-the-hill' lies the plateau of human mortality
Above age 105, the rise in risk of death by age slows -- and even plateaus -- according to a new study, one that provides valuable insight into one of the most fundamental questions of human aging; Is there a fixed maximum lifespan for humans?
Associating frailty to cardiovascular disease and mortality
Frailty is common in elderly people with cardiovascular disease and goes along with elevated mortality.
Increasing tree mortality in a warming world
A mix of factors is contributing to an increasing mortality rate of trees in the moist tropics, where trees in some areas are dying at about twice the rate that they were 35 years ago.
More Mortality News and Mortality Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

In & Out Of Love
We think of love as a mysterious, unknowable force. Something that happens to us. But what if we could control it? This hour, TED speakers on whether we can decide to fall in — and out of — love. Guests include writer Mandy Len Catron, biological anthropologist Helen Fisher, musician Dessa, One Love CEO Katie Hood, and psychologist Guy Winch.
Now Playing: Science for the People

#543 Give a Nerd a Gift
Yup, you guessed it... it's Science for the People's annual holiday episode that helps you figure out what sciency books and gifts to get that special nerd on your list. Or maybe you're looking to build up your reading list for the holiday break and a geeky Christmas sweater to wear to an upcoming party. Returning are pop-science power-readers John Dupuis and Joanne Manaster to dish on the best science books they read this past year. And Rachelle Saunders and Bethany Brookshire squee in delight over some truly delightful science-themed non-book objects for those whose bookshelves are already full. Since...
Now Playing: Radiolab

An Announcement from Radiolab