Using Small Area Variation Analysis to Investigate Sources of Practice Variation for Febrile Infants at Risk for Invasive Bacterial Infections

项目总结 发烧的婴儿有潜在致命的侵袭性细菌感染的风险，但临床决策差异很大， 数以千计的婴儿可能会因为检测不足或治疗过度而受到伤害。实践变更成本最高可达 每年7000亿美元，并与糟糕的结果、低质量的护理和不平等有关。然而，在那里 是缺乏考察关键来源对实践差异的贡献程度的研究，尤其是 适用于发烧的婴儿。解决这一知识差距是提高有效性的重要第一步， 在照顾发烧婴儿方面的效率和公平。耶格尔医生是一名董事会认证的儿科医院医生，他之前 研究的重点是了解临床和社会因素如何改善儿童健康结果。 这个K23指导的以患者为导向的研究职业发展奖将让他学习新的 调查实践差异的来源，了解后续影响，并最终设计 减少实践差异、改善结果和降低成本的干预措施，从而提高 都是发烧的婴儿。拟议的学习和职业发展计划将直接支持候选人的目标 成为临床决策和儿童健康方面的独立临床医生、调查员和专家 公平。为了实现这一目标，他从芝加哥大学组建了一个跨学科的指导团队 罗彻斯特家庭医学系、公共卫生科学系和急诊医学系。除了……之外 完成相关课程、工作坊、纵向培训计划和个别授课课程， 耶格尔博士将从他的团队那里获得专业知识，他们将指导他实现自己的培训和职业目标。 这些目标包括获得以下方面的专业知识和技能：1)决策科学；2)多层次建模；3)混合 方法：研究方法。他的研究计划试图了解发病率、当地资源供应、 临床特征、父母/照顾者偏好以及当地执业文化是导致执业差异的原因 在发烧的婴儿身上。其目的是：1)估计实践的差异和发病率和 本地资源解释实践差异；2)考察与实践差异相关的背景因素； 3)探讨国家临床实践指南对实践变异的影响。他会实现目标的 1使用全州范围、基于人口的行政数据集和小区域差异分析框架 估计实践差异的关键来源对临床决策差异的影响程度- 制作。在目标2中，他将使用混合方法方法来确定可能有助于 影响实践变化的临床决策。在目标3中，他将调查一个国家临床 练习指南减少练习差异。这些职业发展活动、指导和成果 这些研究为候选人获得独立资金研究儿科提供了一条明确的途径 临床决策和解决儿童健康中的不平等问题。

PROJECT SUMMARY Febrile infants are at risk for potentially fatal invasive bacterial infections, but clinical decisions vary widely and thousands of infants may experience harms from under-testing or over-treatment. Practice variation costs up to $700 billion each year and is associated with poor outcomes, low-quality care, and inequities. However, there is a paucity of research examining the extent to which key sources contribute to practice variation, particularly for febrile infants. Addressing this gap in knowledge is an essential first step to improve the effectiveness, efficiency, and equity in care for febrile infants. Dr. Yaeger is a board-certified pediatric hospitalist whose prior research has focused on understanding how clinical and social factors can improve child health outcomes. This K23 Mentored Patient-Oriented Research Career Development Award will allow him to learn new methods to investigate sources of practice variation, understand subsequent effects, and ultimately devise interventions to reduce practice variation, improve outcomes, and decrease costs, thereby improving equity for all febrile infants. The proposed studies and career development plan will directly support the candidate's goal of becoming an independent clinician-investigator and expert in clinical decision-making and child health equity. To achieve this goal, he has assembled an inter-disciplinary mentoring team from the University of Rochester Departments of Family Medicine, Public Health Sciences, and Emergency Medicine. In addition to completing relevant coursework, workshops, longitudinal training programs, and individual didactic sessions, Dr. Yaeger will gain expertise from his team, who will guide him in achieving his Training and Career Goals. These goals include gaining expertise and skills in: 1) decision science; 2) multi-level modeling, and; 3) mixed methods. His research plan seeks to understand the extent to which disease rates, local supply of resources, clinical characteristics, parent/caregiver preferences, and local practice culture contribute to practice variation in febrile infants. The aims are: 1) To estimate practice variation and the extent to which disease rates and local resources explain practice variation; 2) To examine contextual factors associated with practice variation; 3) To investigate the effect of a national clinical practice guideline on practice variation. He will accomplish Aim 1 using a state-wide, population-based administrative dataset and small area variation analysis framework to estimate the extent to which key sources of practice variation contribute to differences in clinical decision- making. In Aim 2, he will use a mixed methods approach to identify contextual factors that may contribute to clinical decisions affecting practice variation. In Aim 3, he will investigate the extent to which a national clinical practice guideline reduces practice variation. These career development activities, mentorship, and results of these studies, provide a clear path for the candidate to secure independent funding to investigate pediatric clinical decision-making and address inequities in child health.