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

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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., James, Brent, Savitz, Lucy, Pavia, Andrew T., Clark, Edward B.·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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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: Byington, Carrie L.
Sheng, Xiaoming
Nelson, Richard E.
Daly, Judy A.
Pavia, Andrew T.
Clark, Edward B.
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: green
www.ncbi.nlm.nih.gov
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 › Pediatrics, Perinatology and Child Health › Neonatal and Maternal Infections
Health Sciences › Medicine › Infectious Diseases › 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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Costs and Infant Outcomes After Implementation of a Care Process Model for Febrile Infants

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