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Cited by 167Neonatal and Maternal InfectionsAntibiotic Use and ResistancePediatric Urology and Nephrology Studies

Costs and infant outcomes after implementation of a care process model for febrile infants

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Byington, Carrie L., Reynolds, Carolyn C., Korgenski, Kent, Sheng, Xiaoming, Valentine, Karen J., Nelson, Richard E., Daly, Judy A., Osguthorpe, Russell J. +4 more·2012·Pediatrics
DOI 10.1542/peds.2012-0127PMC PMC4074609
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Abstract

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.

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  • When a clinical practice guideline is adopted by an institution, more uniform care is provided to febrile infants, which can result in more appropriate use of diagnostic tests, antibiotics, hospitalization, and lower health care costs.

    “However, when a clinical practice guideline (CPG) is adopted by an institution there is more uniform care provided to febrile infants,24 which can result in more appropriate use of diagnostic tests, antibiotics, hospitalization,25 and lower health care costs.26”

    From Impact of Mobile Device-Based Clinical Decision Support Tool on Guideline Adherence and Mental Workload (2019) · cites this paper as [25]

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Authors
Byington, C. L., Reynolds, C. C., Korgenski, K., Sheng, X., Valentine, K. J., Nelson, R. E., Daly, J. A., Osguthorpe, R. J., James, B., Savitz, L., Pavia, A. T., & Clark, E. B.
Affiliations
  • University of Utah (US)
  • Intermountain Healthcare (US)
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
2012-07-01
Volume
130
Issue
1
Pages
e16-e24
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2012-0127
PMC
PMC4074609
OpenAlex
W2007863289
Cited by
167
References
58
Citations by year
2026: 3 · 2025: 4 · 2024: 10 · 2023: 6 · 2022: 11 · 2021: 13 · 2020: 10 · 2019: 18 · 2018: 25 · 2017: 17 · 2016: 11 · 2015: 16 · 2014: 8 · 2013: 13 · 2012: 2
FWCI
12.04
Type
journal article
Language
en
Open access
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5k24hd047249-05)
  • Agency for Healthcare Research and Quality (R18HS018034)
  • National Cancer Institute (KM1CA156723)
  • National Institute of Child Health and Human Development (K24HD047249, R18HS018034)
  • National Center for Research Resources (UL1RR025764, R18HS018034)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (K24- HD047249)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Urology and Nephrology Studies
Keywords
febrile infants, serious bacterial infection, evidence-based care, health care costs, antibiotic stewardship, length of hospital stay, diagnostic testing, urinary tract infection, viral illness, quality improvement
MeSH terms
Anti-Bacterial Agents, Clinical Protocols, Cost-Benefit Analysis, Female, Fever, Humans, Infant, Infant Care, Infant, Newborn, Length of Stay, Male, Outcome and Process Assessment, Health Care, Urinary Tract Infections, Utah, Virus Diseases, Cohort Studies, Program Evaluation, Linear Models, Logistic Models, Bacteremia, Meningitis, Bacterial, Hospital Costs, Quality Improvement

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