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

使用小面积变异分析来调查有侵袭性细菌感染风险的发热婴儿的实践变异来源

• 批准号: 10588846
• 负责人: Jeffrey Paul Yaeger
• 金额: $ 16.69万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-23 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10588846
• 关键词: Academy; Accident and Emergency department; Address; Adoption; Affect; Age; Agreement; American; Antibiotics; Atlases; Bacteremia; Bacterial Infections; Beds; Belief; Biological Markers; Blood; Board Certification; Caregivers; Caring; Characteristics; Child Health; Child health equity; Childhood; Clinical; Clinical Practice Guideline; Code; Complex; Consensus; Data; Data Set; Decision Making; Development Plans; Diagnosis; Disease; Educational workshop; Effectiveness; Emergency Medicine; Ensure; Equity; Family Practice; Fever; Focal Infection; Foundations; Funding; Geography; Goals; Health Sciences; Health Service Area; Hospitalists; Hospitalization; Individual; Inequity; Infant; Infant Health; Intervention; Interview; Intramuscular; Knowledge; Learning; Light; Location; Maps; Medical; Meningitis; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Modeling; National Institute of Child Health and Human Development; New York; Outcome; Parents; Patients; Pattern; Pediatrics; Physicians; Population; Public Health; Publications; Quality of Care; Research; Research Personnel; Residual state; Resources; Risk; Science; Secure; Site; Small-Area Analysis; Small-Area Variations; Source; Spinal Puncture; Testing; Training; Training Programs; Universities; Variant; acute care; administrative database; career; career development; clinical decision-making; contextual factors; cost; density; evidence base; experience; febrile infant; health equity promotion; hospital services; improved; improved outcome; infection rate; knowledge base; multilevel analysis; overtreatment; parenteral administration; pediatric emergency; population based; preference; risk stratification; skills; social factors

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.

项目摘要 发热的婴儿有潜在的致命侵入性细菌感染的风险，但临床决定差异很大，并且 成千上万的婴儿可能因测试或过度治疗而遭受危害。练习变化成本最高 每年7000亿美元，与不良的结果，低质量护理和不平等有关。但是，那里 很少研究主要来源对实践变化的贡献的程度，特别是 对于发热的婴儿。在知识中解决这一差距是提高有效性的重要第一步 效率和对高温婴儿的护理公平。 Yaeger博士是一位经过董事会认证的儿科住院医生 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使他能够学习新的 研究实践变化，了解后续效果并最终设计的方法 减少实践变化，改善结果和降低成本的干预措施，从而提高了权益 所有的好评婴儿。拟议的研究和职业发展计划将直接支持候选人的目标 成为独立的临床医生评估者和临床决策和儿童健康的专家 公平。为了实现这一目标，他召集了来自大学的跨学科指导团队 罗切斯特家庭医学，公共卫生科学和急诊医学部门。此外 完成相关课程，讲习班，纵向培训计划和个人教学会议， Yaeger博士将从他的团队中获得专业知识，后者将指导他实现培训和职业目标。 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）多层建模，以及； 3）混合 方法。他的研究计划试图了解疾病率，本地资源供应的程度， 临床特征，父母/照顾者的偏好和当地实践文化有助于实践变化 在发热婴儿中。目的是：1）估计实践差异以及疾病率和多大程度 当地资源解释实践变化； 2）检查与实践变化相关的上下文因素； 3）研究国家临床实践指南对实践变化的影响。他将完成目标 1使用全州范围内的，基于人群的行政数据集和小面积变化分析框架 估计主要差异的关键来源在多大程度上导致临床决策的差异 - 制作。在AIM 2中，他将使用混合方法来确定可能有助于的上下文因素 影响实践变化的临床决策。在AIM 3中，他将研究国家临床的程度 实践指南减少了实践的变化。这些职业发展活动，指导和结果 这些研究为候选人提供了一条清晰的途径，以确保独立资金研究小儿 临床决策和解决儿童健康的不平等。