Discussion

This scoping review examined the association between published quality indicators for OPAT (Table 1) and readmission rates and described the composition of reported multidisciplinary teams. Across 18 studies involving over 5,000 patients, most OPAT programs had structured teams consistent with IDSA guidelines, ^{Reference Norris, Shrestha and Allison5} though reporting of specific quality indicators varied. None of the studies reported all 12 priority quality indicators proposed by Berrevoets et al., ^{Reference Berrevoets, Ten Oever, Oerlemans, Kullberg, Hulscher and Schouten8} and there was no clear association between the total number of indicators reported and lower readmission rates. However, because of a lack of standardized reporting guidelines for OPAT programs, reporting of each quality indicator was dependent on author discretion and article/journal requirements (such as limited word count). Absence of quality indicator reporting in a study does not necessarily imply absence of the indicator in practice. However, this scoping review provides an initial overview of the prevalence of quality indicator reporting in published OPAT literature.

Interestingly, a greater number of reported quality indicators did not correlate with lower readmission rates. This may reflect heterogeneity in study designs, patient populations, and outcome definitions, as well as differences in implementation fidelity. It also highlights that the presence of quality indicators in program documentation may not equate to consistent real-world application. The quality and sustainability of implementation may ultimately determine patient outcomes more than the number of indicators formally reported.

Variation in outcome definitions further complicates interpretation. Some studies reported only infection-related readmissions, while others included all-cause readmissions, making cross-study comparisons challenging. Standardizing OPAT outcome definitions and reporting frameworks would facilitate more meaningful benchmarking and enable the identification of effective practices.

Organizational indicators, including having a structured OPAT program and a formal multidisciplinary team, were reported in all included studies (as expected given our inclusion criteria of OPAT programs having a multidisciplinary team). This aligns with the 2018 IDSA OPAT guidelines, which emphasize that OPAT should be delivered through a coordinated, structured program with defined oversight by an ID physician and clear communication pathways among clinicians, patients, and caregivers. ^{Reference Norris, Shrestha and Allison5}

All included studies described having an ID physician as part of the OPAT team, underscoring the central role of ID specialists in antimicrobial stewardship and program oversight. Most teams also included registered nurses (94%) and pharmacists (55%), both of whom are essential for daily coordination, drug monitoring, and patient education. However, few programs included social workers/case managers (28%) or hospitalists (11%). The absence of hospitalists is notable because they often play a key role in transitions of care, bridging inpatient and outpatient management. ^{Reference Kripalani, Jackson, Schnipper and Coleman14–Reference Palabindala and Abdul Salim16} Their involvement could enhance communication at discharge, promote continuity of care, and address logistical challenges that contribute to readmission. In addition, increasing hospitalist involvement, for example by integration of OPAT into standard discharge workflows, could potentially lower the burden on ID specialists. Likewise, social workers are critical in assessing patient support systems, housing stability, and financial barriers—factors that directly affect OPAT adherence and safety. The IDSA guidelines recommend including case managers or social workers within the OPAT team to ensure comprehensive discharge planning and patient support. ^{Reference Norris, Shrestha and Allison5} While reporting the presence of hospitalists or social workers was not correlated with low readmission rates in our analysis, other factors (such as patient population) may have impacted these rates as discussed above. While hospitalist and social worker involvement presents an opportunity to improve OPAT care, their roles are likely necessary but not sufficient to lower readmission rates.

Quality indicator reporting frequency varied between the domains (Table 2). Many studies reported quality indicators in the organization and initiation domains (Table 2), suggesting that most programs have strong initiation processes in place. Structured OPAT programs provide consistency in patient selection, antimicrobial monitoring, and follow-up and have been shown to reduce unplanned readmissions and complications. Initial assessment by a competent team member was associated with lower readmission rates. Additionally, most studies reported that patients and caregivers were informed about OPAT prior to its initiation. These findings reinforce the IDSA recommendation that all OPAT candidates undergo a formal multidisciplinary assessment of clinical stability, vascular access, and home environment before discharge. ^{Reference Norris, Shrestha and Allison5,Reference Chapman, Seaton and Cooper17} Structured education on therapy and catheter care ensures that patients and caregivers can identify early complications and contact the OPAT team promptly, thereby preventing avoidable hospital readmissions.

In contrast, continuation domain quality indicators such as rapid communication of laboratory results or urgent review of clinical problems, were infrequently reported. Only one study described a system to ensure laboratory results were delivered to physicians within 24 h, and very few studies detailed processes for urgent clinical review. Because of lack of reporting of indicators in the Continuation domain, it is unknown whether mechanisms for ongoing monitoring and communication remain underdeveloped or just unreported. The IDSA guidelines explicitly recommend regular laboratory and clinical monitoring and readily available communication channels between patients and providers to address emerging issues during therapy. ^{Reference Norris, Shrestha and Allison5,Reference Paladino and Poretz18} Failure to document or implement these practices could contribute to complications such as catheter-related infections or antibiotic toxicities, leading to higher readmission rates.

Likewise, few studies reported outcome domain quality indicators (Table 2). Only three studies mentioned any formal mechanism for ongoing quality assessment. This lack of outcome reporting limits benchmarking and quality improvement across institutions. The IDSA guidelines explicitly encourage programs to track and review key outcomes including treatment completion, readmissions, and adverse events to guide program development and ensure accountability. ^{Reference Norris, Shrestha and Allison5} The limited documentation of such monitoring underscores a gap in translating these recommendations into practice.