Project Abstract
This project focuses on evaluating health equity in the provision of home-based outpatient parenteral antibiotic therapy (OPAT). Home-based OPAT is a strategy whereby patients requiring extended courses of parenteral (typically intravenous) antibiotic therapy are discharged from the hospital prior to completion of their antibiotic treatment course. This approach provides cost savings to both hospitals and patients, and it allows patients to return to their home environments without interruption of critical medical intervention. It requires access to refrigeration so that antibiotic solutions can be stored in the patient’s home, and it requires stable housing so that visiting healthcare providers can visit patients both on a routine basis and as problems arise. A variety of service providers collaborate to safely provide OPAT to patients, including hospital staff, outpatient clinic staff, home healthcare agencies and home infusion pharmacies; these providers must be able to communicate with each other, and with the patient’s medical team. However, it is unclear whether OPAT is offered to patients in an equitable fashion. This project will begin to explore pharmacoequity in the provision of OPAT among patients discharged from Northwestern Memorial Hospital (NMH). The electronic health record (EHR) will be utilized to procure data which will then be analyzed to establish whether patients with specified demographic parameters receive OPAT at a lower rate compared to the general population of patients hospitalized at NMH. Key demographic parameters which will serve as the focus of the analysis will include race, ethnicity, ZIP code and social determinants of health (SDOH) as reported into the EHR’s built-in SDOH questionnaire. Co-existing medical conditions such as substance use disorder and injection drug use will be similarly evaluated as possible modulating factors in the provision of OPAT services to patients who would otherwise qualify for them. Identification of such factors will provide both a roadmap for development of interventions to improve health equity across Chicagoland, and pilot data for further quantitative and qualitative work assessing such interventions.
Investigators
Muhammad Dhanani
Dr. Dhanani is an assistant professor in the Department of Medicine at Feinberg School of Medicine. He completed his medical degree at University of Michigan Medical School and then pursued postgraduate training in internal medicine and infectious diseases at Boston Medical Center, the primary teaching hospital for Boston University School of Medicine. Boston Medical Center is the traditional safety net hospital for the city of Boston, and it cares for a diverse patient population; about one-quarter of the patients it serves utilize a language other than English as their primary language. It is deeply engaged in working with minoritized and underprivileged populations, hosting cutting edge programs in addiction medicine and standing across the street from the main facility of the Boston Healthcare for the Homeless Program. Training in this milieu inspired Dr. Dhanani to commit to efforts to promote equity in healthcare, and his earliest research activity in infectious diseases explored the challenges faced by persons who inject drugs as they navigate treatment for injection drug use-associated infective endocarditis, a condition which imparts high risk of morbidity and mortality. He is eager to collaborate with and learn from other faculty across Northwestern University as a member of the Race And Justice Collaborative Fellowship.
Anne Kurze
Anne graduated from Marquette University and then became a nurse at Children’s Memorial Hospital. She moved to Northwestern Medicine’s Solid Organ Transplantation Clinic in 2011. She worked as a staff nurse until completing her Master’s degree in nursing at North Park University. She completed her master’s program in 2016. She was the first Advanced Practice Provider within the Division of Infectious Disease. Her clinical interests include quality improvement, education of new graduate APPs as well as preceptorship of physician assistant and nurse practitioner students. Outside of work, she enjoys cooking, spending time outside and organizing monthly get-together dinners (Stammtisch) with friends.