The DOI matches its Crossref record; 58 of the 58 references it cites were found in a registry or an index.
Costs and Infant Outcomes After Implementation of a Care Process Model for Febrile Infants
Open accessAbstract
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.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“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]
Citations
Cites
Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010.
Schrag, S. D., Gorwitz, R. J., Fultz-Butts, K., & Schuchat, A. (2002) · PubMed · Cited by 3,120
Sexually Transmitted Diseases 7982 Treatment Guidelines
Workowski, K., & Berman, S. M. (1982) · American Pharmacy · doi:10.1016/s0160-3450(16)31823-2 · Cited by 1,577
Agency for Health Care Policy and Research
Eisenberg, J. M. (1999) · Medical Care · doi:10.1097/00005650-199903000-00001 · Cited by 1,373
Outpatient Management without Antibiotics of Fever in Selected Infants
Baker, M. D., Bell, L. M., & Avner, J. R. (1993) · New England Journal of Medicine · doi:10.1056/nejm199311113292001 · Cited by 472
Baraff, L. J., Bass, J. W., FLEISHER, G. R., Klein, J. O., McCracken, G. H., Powell, K. R., & Schriger, D. L. (1993) · Annals of Emergency Medicine · doi:10.1016/s0196-0644(05)80991-6 · Cited by 462
Is Health Care Ready for Six Sigma Quality?
Chassin, M. R. (1998) · Milbank Quarterly · doi:10.1111/1468-0009.00106 · Cited by 389
Baskin, M. N., OʼRourke, E. J., & FLEISHER, G. R. (1992) · The Journal of Pediatrics · doi:10.1016/s0022-3476(05)80591-8 · Cited by 362
Jaskiewicz, J. A., McCarthy, C. A., Richardson, A. C., White, K. C., Fisher, D. J., Powell, K. R., Dagan, R., & Groups, F. I. C. S. (1994) · PEDIATRICS · doi:10.1542/peds.94.3.390 · Cited by 349
Dagan, R., Powell, K. R., Hall, C. B., & Menegus, M. A. (1985) · The Journal of Pediatrics · doi:10.1016/s0022-3476(85)80175-x · Cited by 348
Jaskiewicz, J. A., McCarthy, C. A., Ac, R., Kc, W., Dj, F., Dagan, R., & Kr, P. (1994) · PubMed · Cited by 345
Research works printed but not linked: 1
- Gesteland, 2007, A Method for Identifying Febrile Infants Presenting to the Emergency Department Using Administrative Data
Cited by
Sorted by citations
Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old
Pantell, R. H., Roberts, K. B., Adams, W. G., Dreyer, B. P., Kuppermann, N., O’Leary, S. T., Okechukwu, K., Woods, C. R., Byington, C. L., Lavelle, J. M., et al. (2021) · PEDIATRICS · doi:10.1542/peds.2021-052228 · Cited by 461
Self-citationKuppermann, N., Dayan, P. S., Levine, D. A., Vitale, M., Tzimenatos, L. S., Tunik, M. G., Saunders, M., Ruddy, R. M., Roosevelt, G., Rogers, A. J., et al. (2019) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2018.5501 · Cited by 378
Variation in Care of the Febrile Young Infant <90 Days in US Pediatric Emergency Departments
Aronson, P. L., Thurm, C. W., Alpern, E. R., Alessandrini, E. A., Williams, D. J., Shah, S. S., Nigrovic, L. E., McCulloh, R. J., Schondelmeyer, A. C., Tieder, J. S., et al. (2014) · PEDIATRICS · doi:10.1542/peds.2014-1382 · Cited by 235
Accuracy of the Urinalysis for Urinary Tract Infections in Febrile Infants 60 Days and Younger
Tzimenatos, L. S., Mahajan, P., Dayan, P. S., Vitale, M., Linakis, J. G., Blumberg, S., Borgialli, D. A., Ruddy, R. M., Buren, J. V., Ramilo, O., et al. (2018) · PEDIATRICS · doi:10.1542/peds.2017-3068 · Cited by 131
Epidemiology of Bacteremia in Febrile Infants in the United States
Biondi, E., Evans, R. C., Mischler, M. J., Bendel-Stenzel, M. R., Horstmann, S., Lee, V., Aldag, J. C., & Gigliotti, F. (2013) · PEDIATRICS · doi:10.1542/peds.2013-1759 · Cited by 130
Metadata
- 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
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
