Practice Variation Project

Practice Variation in Febrile Infants at Risk for Invasive Bacterial Infections

Background

Emergency department clinical decisions vary widely for febrile infants, who are at risk for potentially fatal invasive bacterial infections; some infants may experience harms from under-testing or over-treatment. There is a gap in scientific knowledge regarding how clinicians make decisions for febrile infants and the extent to which key sources contribute to practice variation. Addressing this gap will provide a foundation to improve care to febrile infants and promoting health equity.

Objectives

• Estimate practice variation for clinical decisions in febrile infants and examine the impact of local disease rates and resources
• Examine contextual factors associated with practice variation
• Investigate the effect on practice variation of a national clinical practice guideline

Research Methods

• Mixed methods
• Small area variation analysis
• Multi-level modeling

Implications

Findings will identify discrete factors associated with practice variation and examine outcomes, quality, costs and possible inequities in febrile infants. Subsequent studies will mechanistically map out practice variation to identify specific points of intervention. 

Funding Statement

This project: Using Small Area Variation Analysis to Investigate Sources of Practice Variation for Febrile Infants at Risk for Invasive Bacterial Infections (1 K23HD107182-01A1) is funded by the National Institute of Child Health and Human Development. 

Collaborators

• Kevin Fiscella, MD, MPH
• Amina Alio, PhD
• Peter Veazie, PhD
• Ashkan Ertefaie, PhD
• Elaine Hill, PhD