Transitioning antimicrobial stewardship beyond the hospital: the Cleveland Clinic's community-based parenteral...

One of the tenets of value-based health care is a focus on providing benefits to patients, as measured by better health outcomes per dollar spent rather than minimizing costs. In fact, proponents of value-based health care argue that the best way to reduce health care costs is through a focused approach to improving health outcomes. Associated with this approach is the need to measure outcomes over the full cycle of care, not simply for services rendered while an inpatient. This article examines the community-based parenteral anti-infective therapy program at the Cleveland Clinic as a model for antimicrobial stewardship for patients requiring parenteral antimicrobial therapy at the time of discharge from the inpatient setting. The program is a patient needs-focused, coordinated team effort that mandates inpatient infectious disease consultation for patients requiring community-based parenteral anti-infective therapy. An examination of some of the features of the Cleveland Clinic program should provide guidance for other institutions seeking to improve the care of their patients requiring parenteral anti-infectives when transitioning care from the acute setting.