Document Detail

Costs and infant outcomes after implementation of a care process model for febrile infants.
MedLine Citation:
PMID:  22732178     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Febrile infants in the first 90 days may have life-threatening serious bacterial infection (SBI). Well-appearing febrile infants with SBI cannot be distinguished from those without by examination alone. Variation in care resulting in both undertreatment and overtreatment is common.
METHODS: We developed and implemented an evidence-based care process model (EB-CPM) for the management of well-appearing febrile infants in the Intermountain Healthcare System. We report an observational study describing changes in (1) care delivery, (2) outcomes of febrile infants, and (3) costs before and after implementation of the EB-CPM in a children's hospital and in regional medical centers.
RESULTS: From 2004 through 2009, 8044 infants had 8431 febrile episodes, resulting in medical evaluation. After implementation of the EB-CPM in 2008, infants in all facilities were more likely to receive evidence-based care including appropriate diagnostic testing, determination of risk for SBI, antibiotic selection, decreased antibiotic duration, and shorter hospital stays (P < .001 for all). In addition, more infants had a definitive diagnosis of urinary tract infection or viral illness (P < .001 for both). Infant outcomes improved with more admitted infants positive for SBI (P = .011), and infants at low risk for SBI were more often managed without antibiotics (P < .001). Although hospital admissions were shortened by 27%, there were no cases of missed SBI. Health Care costs were also reduced, with the mean cost per admitted infant decreasing from $7178 in 2007 to $5979 in 2009 (-17%, P < .001).
CONCLUSIONS: The EB-CPM increased evidence-based care in all facilities. Infant outcomes improved and costs were reduced, substantially improving value.
Carrie L Byington; Carolyn C Reynolds; Kent Korgenski; Xiaoming Sheng; Karen J Valentine; Richard E Nelson; Judy A Daly; Russell J Osguthorpe; Brent James; Lucy Savitz; Andrew T Pavia; Edward B Clark
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.     Date:  2012-06-25
Journal Detail:
Title:  Pediatrics     Volume:  130     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-07-03     Completed Date:  2012-09-10     Revised Date:  2014-07-02    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e16-24     Citation Subset:  AIM; IM    
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MeSH Terms
Anti-Bacterial Agents / therapeutic use
Bacteremia / complications,  diagnosis,  economics,  therapy
Clinical Protocols
Cohort Studies
Cost-Benefit Analysis
Fever / economics,  etiology,  therapy*
Hospital Costs*
Infant Care / organization & administration*
Infant, Newborn
Length of Stay / statistics & numerical data
Linear Models
Logistic Models
Meningitis, Bacterial / complications,  diagnosis,  economics,  therapy
Outcome and Process Assessment (Health Care)*
Program Evaluation
Quality Improvement*
Urinary Tract Infections / complications,  diagnosis,  economics,  therapy
Virus Diseases / complications,  diagnosis,  economics,  therapy
Grant Support
Reg. No./Substance:
0/Anti-Bacterial Agents
Comment In:
Pediatrics. 2012 Jul;130(1):e199-200   [PMID:  22732175 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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