The purpose of this K24 application is to support the patient-oriented research performed by Carrie Byington, MD and to provide her with career development opportunities that will enhance her ability to mentor young clinical investigators, especially women and minorities. The research application focuses on the application of computerized decision support to the management of the febrile infant 1-90 days of age. The evaluation and management of fever accounts for 20% of medical encounters in this age group. There is significant variation in the management of febrile infants and this variation has serious implications for patient safety and health care cost. In the last decade, research data has been generated that could be translated into improved quality of care for febrile infants in the US. Using data I have collected and analyzed over the last 9 years, I have developed a method for the management of the febrile infant, that incorporates viral diagnostic testing, that I believe will improve care and patient safety by providing physicians with information needed to calculate an individual infant's risk of bacterial infection. This algorithm exists as a computerized Bayesian model that must be tested prospectively. I hypothesize that 1) There is significant and inappropriate variation among Intermountain Health Care (IHC) physicians in the diagnosis and management of febrile infants, 2) variation will be reduced by the use of a decision support module that is based on a software program that integrates new data and diagnostic methods, and 3) The use of the module will result in a 50% reduction in length of stay and in duration of antibiotic treatment for febrile infants with no increase in missed cases of serious bacterial infection.
The Specific Aims of this project are: 1) Determine baseline practices regarding the evaluation and management of febrile infants at three IHC facilities (Primary Children's, Utah Valley, and McKay Dee Medical Centers) from 2000-2004 by analyzing data from the computerized IHC Data warehouse, 2) Implement, during a 24-month period, the decision support tool at the same three hospitals, 3) Compare data obtained before and after computerized decision support was available to determine whether improvements in patient care and safety can be documented. This project can provide data that will improve the care of the febrile infant regionally and can inform future national studies.
|Adler, Frederick R; Stockmann, Chris; Ampofo, Krow et al. (2018) Transmission of rhinovirus in the Utah BIG-LoVE families: Consequences of age and household structure. PLoS One 13:e0199388|
|Blaschke, Anne J; Korgenski, E Kent; Wilkes, Jacob et al. (2018) Rhinovirus in Febrile Infants and Risk of Bacterial Infection. Pediatrics 141:|
|Byington, Carrie L; Keenan, Heather; Phillips, John D et al. (2016) A Matrix Mentoring Model That Effectively Supports Clinical and Translational Scientists and Increases Inclusion in Biomedical Research: Lessons From the University of Utah. Acad Med 91:497-502|
|Byington, Carrie L; Ampofo, Krow; Stockmann, Chris et al. (2015) Community Surveillance of Respiratory Viruses Among Families in the Utah Better Identification of Germs-Longitudinal Viral Epidemiology (BIG-LoVE) Study. Clin Infect Dis 61:1217-24|
|Glissmeyer, Eric W; Korgenski, E Kent; Wilkes, Jacob et al. (2014) Dipstick screening for urinary tract infection in febrile infants. Pediatrics 133:e1121-7|
|Doby, Elizabeth H; Stockmann, Chris; Korgenski, E Kent et al. (2013) Cerebrospinal fluid pleocytosis in febrile infants 1-90 days with urinary tract infection. Pediatr Infect Dis J 32:1024-6|
|Blaschke, Anne J; Byington, Carrie L; Ampofo, Krow et al. (2013) Species-specific PCR improves detection of bacterial pathogens in parapneumonic empyema compared with 16S PCR and culture. Pediatr Infect Dis J 32:302-3|
|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|
|Blaschke, Anne J; Heyrend, Caroline; Byington, Carrie L et al. (2012) Rapid identification of pathogens from positive blood cultures by multiplex polymerase chain reaction using the FilmArray system. Diagn Microbiol Infect Dis 74:349-55|
|Stockmann, Chris; Ampofo, Krow; Hersh, Adam L et al. (2012) Evolving epidemiologic characteristics of invasive group a streptococcal disease in Utah, 2002-2010. Clin Infect Dis 55:479-87|
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