Evaluation of an Evidence-Based Care Process Model (EB-CPM) for Febrile Infants

描述（由申请人提供）：在我们题为“发热婴儿循证护理过程模型（EB-CPM）的评价”的提案中，我们将对成功实施循证质量改进干预（QII）进行深入研究，目标是婴儿，因为我们将EB-CPM推广到Intermountain Healthcare内的各种急诊和门诊环境。在我们的传播计划中，我们的目标是犹他州和爱达荷州被列为联邦关键访问医院的设施。几个专业组织，包括儿科研究办公室设置（PROS）网络，美国儿科学会，医疗保健机构 研究和质量，和医学研究所（IOM）已经认识到1-90天的发热婴儿的紧急管理作为研究和翻译策略的优先事项，以改善护理。犹他州大学和Intermountain组建了一支经验丰富的跨学科团队来创建和实施EB-CPM。该团队开发了一个强有力的基于证据的CPM，映射到所有六个IOM域，以提高质量。EB-CPM包括关于实验室检测的指导，包括常规和病毒诊断，使用实验室检测结果来分配严重细菌感染（SBI）的风险，并告知在门诊环境中接收或管理婴儿的决定，病毒性疾病和SBI之间的关系，SBI流行病学和抗生素治疗，以及住院婴儿安全出院的时间。在四个试点Intermountain Healthcare医院成功实施了EB-CPM，为深入研究提供了证据基础和基础，旨在确定与EB-CPM成功相关的实施过程和背景。我们假设与成功实施EB-CPM相关的因素可以被识别并推广到其他医疗环境。我们假设，新的战略，如保持认证（MOC）与QII的对齐将与维持和传播成功的QII资源有限的农村设施。通过具体目标，我们的团队将：1）对管理人员、实验室人员、护理人员和医疗保健提供者进行半结构化定性访谈，并对已实施EB-CPM管理发热婴儿的四家试点山间医院进行现场访问，2）从两个角度检查实施发热婴儿方案的成本效益：1）以人口为基础，我们着眼于评估对质量调整生命年的影响;以及2）组织方面，我们通过观察对a）报销和B）运营费用比率的影响，3）分析引入EB-CPM用于发热婴儿的管理，作为QII，可用于满足美国儿科委员会（ABP）制定的儿科MOC要求。我们的研究结果将通过我们与ABP和儿科质量联盟的合作，推动EB-CPM在全国范围内的传播， 改进第一倡议（http：//www.kidsquality.org/）。

DESCRIPTION (provided by the applicant): In our proposal entitled, Evaluation of an Evidence-Based Care Process Model (EB-CPM) for Febrile Infants we will conduct an in-depth study of the implementation of a successful evidence-based quality improvement intervention (QII), targeting infants as we spread the EB-CPM to diverse emergency and ambulatory settings within Intermountain Healthcare. In our dissemination plan, we have targeted facilities classified as Federal Critical Access Hospitals in Utah and Idaho. Several professional organizations including the Pediatric Research in Office Settings (PROS) network, the American Academy of Pediatrics, the Agency for Healthcare Research and Quality, and the Institute of Medicine (IOM) have recognized the emergency management of the febrile infant 1-90 days of age as a priority for both research and translational strategies to improve care. The University of Utah and Intermountain assembled an experienced interdisciplinary team to create and implement the EB-CPM. The team developed a strong evidence-based CPM that maps to all six IOM domains for quality improvement. The EB-CPM includes guidance around laboratory testing, both conventional and viral diagnostics, the use of laboratory test results to assign risk for serious bacterial infection (SBI) and to inform the decision to admit or manage the infant in the outpatient setting, the relationship between viral illness and SBI, SBI epidemiology and antibiotic treatment, and timing the safe discharge of hospitalized infants. The successful implementation of the EB-CPM for febrile infants at four pilot Intermountain Healthcare hospitals provides the evidence base and foundation for in-depth research directed at identifying implementation processes and contexts associated with the success of the EB-CPM. We hypothesize that factors associated with successful implementation of our EB-CPM can be identified and generalized to other healthcare settings. We hypothesize that novel strategies, such as the alignment of maintenance of certification (MOC) with QII will be associated with sustaining and disseminating successful QIIs to resource limited rural facilities. Through the Specific Aims our team will: 1) Conduct semi-structured qualitative interviews of administrators, laboratory personnel, nursing staff, and healthcare providers and site visits at the four pilot Intermountain hospitals that have implemented the EB-CPM for the management of the febrile infant, 2) Examine the cost effectiveness of implementing the febrile infant protocol from two perspectives: 1) population-based whereby we look at assessing the impact on quality adjusted life years; and 2) organizational whereby we look at the impact on a) reimbursement and b) operating to expense ratios, and 3) Analyze the effect of including the EB-CPM for the management of the febrile infant as a QII that can be used to satisfy the requirements for the Pediatric MOC established by the American Board of Pediatrics (ABP). The results of our research will drive the dissemination of the EB-CPM nationally through our collaborations with the ABP and the Alliance for Pediatric Quality, Improve First Initiative (http://www.kidsquality.org/).