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AHRQ 2010 Annual Meeting Improving the Care of the Febrile Infant: Lessons Learned from AHRQ’s Implementation Scienc PowerPoint Presentation
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AHRQ 2010 Annual Meeting Improving the Care of the Febrile Infant: Lessons Learned from AHRQ’s Implementation Science Awards. Carrie L. Byington, MD HA and Edna Benning Presidential Professor of Pediatrics University of Utah Lucy Savitz, PhD Director of Research and Education

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AHRQ 2010 Annual MeetingImproving the Care of the Febrile Infant: Lessons Learned from AHRQ’s Implementation Science Awards

Carrie L. Byington, MD

HA and Edna Benning Presidential Professor of Pediatrics

University of Utah

Lucy Savitz, PhD

Director of Research and Education

Intermountain Healthcare

background
Background
  • Fever in infants 1-90 days of age is one of the most common reasons for medical encounters
    • 20% of all medical encounters in first 90 days
    • 58% of all ED visits at PCMC
  • Fever of > 38°C is associated with seriousbacterial infection (SBI)
    • ~ 10% will have bacteremia, meningitis, or UTI
  • Significant variation in care
    • Low compliance with guidelines
    • Recognized as a research priority by AAP, ABP, IOM, PROS
what are we doing about the febrile infant at intermountain healthcare
What are we Doing About the Febrile Infant at Intermountain Healthcare?
  • Not-for-profit hospitals,
  • physician group, and
  • health plan
  • 24 Hospitals
  • 144 Clinics
  • 736 employed & 2,000+ affiliated physicians
  • Serves about ½ of the
  • Utah’s population of about 2.8 million
intermountain s clinical integration structure
Intermountain’s Clinical Integration Structure
  • Clinical excellence is our core business.
  • Implementation of evidence-based medicine as an institutional responsibility, rather than responsibility of individual physicians.
  • Process identification & priority setting.
  • Process and outcomes improvement through clinical programs structure.
clinical programs
Clinical Programs
  • Care organized by clinical services across the system (shared work processes rather than traditional departments)
  • Led by practicing clinicians (physicians, nurses)
  • Supported by operational and administrative staff and other clinicians from allied specialties
intermountain clinical programs
Intermountain Clinical Programs
  • Behavioral Health
  • Cardiovascular Medicine and Surgery
  • General Surgery
  • Intensive Medicine
  • Oncology
  • Patient Safety
  • Pediatric Specialties
  • Primary Care
  • Women and Newborn
challenge moving evidence into practice
Challenge: Moving Evidence into Practice

Reducing variation in compliance with evidence-based guidelines.

  • Care Process Models (CPMs) are narrative documents that aim at representing state-of-the-art medical knowledge.  
  • Clinical Decision Support Tools can include all ways in which health care knowledge is represented in health information systems.
    • Advantages of computerized EB-CPM:
      • Provide readily accessible references and allow access to knowledge in guidelines that have been selected for use in a specific clinical context
      • Often improve the clarity of a guideline
      • Can be tailored to a patient’s clinical state
      • Propose timely decision support that is specific for the patient
key components of our strategy
Key components of our strategy…

Identify problem

Establish evidence base

Develop, test, & implement using quality improvement tools (e.g., Six Sigma—define, measure, analyze, improve, control)

The University of Utah/Intermountain Febrile Infant EB-CPM was developed using an evidence base derived from prospective research at our institutions & others together with a Six Sigma process.

key quality measures included in the eb cpm the intervention
Key Quality Measures Included in the EB-CPM (The Intervention)

Core Laboratory Testing (CBC and UA)

Admit Patients High Risk for SBI

Viral Testing (EV and Respiratory Viruses)

Appropriate Antibiotics

Stop Antibiotics within 36 hours for Infants with Negative Bacterial Cultures

LOS 42 hours or less

implementation process key steps
Implementation Process: Key Steps

Clinical Program

Discussion

Building EB

17 Publications

Facility Intro by

Champion

QI Test of Change

Six Sigma @ PCMC

Staff

Meetings

Ready Access to

Tools

Comparative

Data Monitoring

evaluation of an evidence based care process model for febrile infants mixed methods study aims
Evaluation of an Evidence-Based Care Process Model for Febrile InfantsMixed Methods Study Aims

Semi-structured interviews to identify themes and unique aspects related to the implementation process, generating data to inform the spread

  • Hypothesis: the successful implementation of the EB-CPM at each facility required multiple and different factors as well as crosscutting themes.

Cost effectiveness of implementing the EB-CPM

Effect of offering the EB-CPM for Pediatric MOC

AHRQ 1 R18 HS018034-01, 7/1/09-6/30/11

aim 1 qualitative analysis of factors related to implementation of the eb cpm
Aim 1 Qualitative Analysis of Factors Related to Implementation of the EB-CPM

The 7S Framework of McKinsey