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.
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