Costs and infant outcomes after implementation of a care process model for febrile infants.
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.
Department of Pediatrics, University of Utah, Salt Lake City, Utah 84108, USA. carrie.byington@hsc.utah.edu
Carrie L
CL
Byington
Carolyn C
CC
Reynolds
Kent
K
Korgenski
Xiaoming
X
Sheng
Karen J
KJ
Valentine
Richard E
RE
Nelson
Judy A
JA
Daly
Russell J
RJ
Osguthorpe
Brent
B
James
Lucy
L
Savitz
Andrew T
AT
Pavia
Edward B
EB
Clark
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D002985:Clinical Protocols; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005334:Fever / Q000191:economics / Q000209:etiology / Q000628:therapy*; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000458:organization & administration*; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D058996:Quality Improvement; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D014589:Utah; D014777:Virus Diseases / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000628:therapy
D000900:Anti-Bacterial Agents