: In our proposal entitled, Evaluation of an Evidence-Based Care Process Model (EB-CPM) for Febrile Infants we will conduct an in-depth study of the implementation of a successful evidence-based quality improvement intervention (QII), targeting infants as we spread the EB-CPM to diverse emergency and ambulatory settings within Intermountain Healthcare. In our dissemination plan, we have targeted facilities classified as Federal Critical Access Hospitals in Utah and Idaho. Several professional organizations including the Pediatric Research in Office Settings (PROS) network, the American Academy of Pediatrics, the Agency for Healthcare Research and Quality, and the Institute of Medicine (IOM) have recognized the emergency management of the febrile infant 1-90 days of age as a priority for both research and translational strategies to improve care. The University of Utah and Intermountain assembled an experienced interdisciplinary team to create and implement the EB-CPM. The team developed a strong evidence-based CPM that maps to all six IOM domains for quality improvement. The EB-CPM includes guidance around laboratory testing, both conventional and viral diagnostics, the use of laboratory test results to assign risk for serious bacterial infection (SBI) and to inform the decision to admit or manage the infant in the outpatient setting, the relationship between viral illness and SBI, SBI epidemiology and antibiotic treatment, and timing the safe discharge of hospitalized infants. The successful implementation of the EB-CPM for febrile infants at four pilot Intermountain Healthcare hospitals provides the evidence base and foundation for in-depth research directed at identifying implementation processes and contexts associated with the success of the EB-CPM. We hypothesize that factors associated with successful implementation of our EB-CPM can be identified and generalized to other healthcare settings. We hypothesize that novel strategies, such as the alignment of maintenance of certification (MOC) with QII will be associated with sustaining and disseminating successful QIIs to resource limited rural facilities. Through the Specific Aims our team will: 1) Conduct semi-structured qualitative interviews of administrators, laboratory personnel, nursing staff, and healthcare providers and site visits at the four pilot Intermountain hospitals that have implemented the EB-CPM for the management of the febrile infant, 2) Examine the cost effectiveness of implementing the febrile infant protocol from two perspectives: 1) population-based whereby we look at assessing the impact on quality adjusted life years;and 2) organizational whereby we look at the impact on a) reimbursement and b) operating to expense ratios, and 3) Analyze the effect of including the EB-CPM for the management of the febrile infant as a QII that can be used to satisfy the requirements for the Pediatric MOC established by the American Board of Pediatrics (ABP). The results of our research will drive the dissemination of the EB-CPM nationally through our collaborations with the ABP and the Alliance for Pediatric Quality, Improve First Initiative (www.kidsquality.org/).

Public Health Relevance

- RELEVANCE TO PUBLIC HEALTH Fever is the most common reason for emergency ambulatory visits in this age group and sepsis is the most common infectious cause of infant death in the US. The recognition of infants at risk for sepsis is critical, because both the over and under-treatment of febrile infants results in significant harm to the infant, the family, and the healthcare institutions. The EB-CPM for the management of the febrile infant gives healthcare providers tools to appropriately evaluate these infants and to improve outcomes for all stakeholders;important for providers in rural settings to improve the equity and safety of care delivered.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Health Systems Research (HSR)
Program Officer
Hagan, Michael
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University of Utah
Schools of Medicine
Salt Lake City
United States
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Byington, Carrie L; Reynolds, Carolyn C; Korgenski, Kent et al. (2012) Costs and infant outcomes after implementation of a care process model for febrile infants. Pediatrics 130:e16-24
Jhaveri, Ravi; Byington, Carrie L; Klein, Jerome O et al. (2011) Management of the non-toxic-appearing acutely febrile child: a 21st century approach. J Pediatr 159:181-5